Individual
JOHN MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4214 DAVENPORT ST, OMAHA, NE 68131-2242
(330) 687-5108
Mailing address
4214 DAVENPORT ST, OMAHA, NE 68131-2242
(330) 687-5108
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/28/2023
Last updated
01/07/2025
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