Individual
DR. EDITH DIANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
615 LILLY RD NE STE 175, OLYMPIA, WA 98506-5179
(360) 486-6772
(360) 486-6775
Mailing address
615 LILLY RD NE STE 175, OLYMPIA, WA 98506-5179
(360) 486-6772
(360) 486-6775
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
36402
CO
208800000X
Urology Physician
Primary
5500A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110601500
—
WY
01
—
W9209
CLINIC MCAR #
—
Enumeration date
09/22/2006
Last updated
08/29/2011
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