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Individual

MS. STELLA ELIZABETH WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.T.

Contact information

Practice address
500 STONE LAKE ROAD, DULCE, NM 87528
(575) 759-7309
(575) 759-7294
Mailing address
500 STONE LAKE ROAD, DULCE, NM 87528
(575) 759-7309
(575) 759-7294

Taxonomy

Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
TN 26432
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
HSZ196
MEDICARE PART B
NM
05
K3526
NM
Enumeration date
04/19/2011
Last updated
06/13/2012
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