Individual
MS. STAR DIANNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
8989 HURON ST, THORNTON, CO 80260-6858
(303) 853-3593
Mailing address
10925 MANET WAY, NORTHGLENN, CO 80234-3315
(303) 254-9567
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
100389
CO
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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