Individual
GRACE ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(717) 531-5638
(717) 531-0983
Mailing address
500 UNIVERSITY DR MC CA410, HERSHEY, PA 17033-2360
(717) 531-5208
(717) 531-0119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA060733
PA
363A00000X
Physician Assistant
OA004865
PA
363AM0700X
Medical Physician Assistant
Primary
MA060733
PA
363AM0700X
Medical Physician Assistant
OA004865
PA
363AS0400X
Surgical Physician Assistant
MA060733
PA
363AS0400X
Surgical Physician Assistant
OA004865
PA
Other
Enumeration date
08/06/2019
Last updated
04/05/2025
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