Individual
AMANDA L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PEDIATRIC NP
Contact information
Practice address
358 E CHICAGO ST STE 202, COLDWATER, MI 49036-2073
(517) 279-5252
Mailing address
17444 Q DR N, MARSHALL, MI 49068-9418
(517) 243-7774
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704264564
MI
363LP0200X
Pediatric Nurse Practitioner
Primary
4704264564
MI
Other
Enumeration date
08/04/2020
Last updated
02/28/2025
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