Individual
MARILYN P WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218
Mailing address
123 FRONTAGE A RD, GRAY, LA 70359-6301
(985) 580-1200
(985) 580-1218
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A10525
LA
Other
Enumeration date
01/25/2006
Last updated
07/26/2007
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