Individual
KUTIA T. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12100 SAMSUNG BLVD, AUSTIN, TX 78754-1903
(123) 456-7890
Mailing address
5080 SPECTRUM DR, SUITE 1200 WEST, ADDISON, TX 75001-4648
(800) 232-3550
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
J01532
TX
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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