Individual
ANN M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
18800 SCHNUCKS DR STE B, WARRENTON, MO 63383-1121
(636) 456-3413
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000549
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104984
BLUE SHIELD OF MISSOURI
MO
01
—
2700007
UNITED HEALTHCARE
MO
05
—
302605282
—
MO
01
—
990003939
RR MCR
—
Enumeration date
08/20/2006
Last updated
06/12/2024
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