Individual
KATHRYN REGINA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4010 W 65TH ST, EDINA, MN 55435-1706
(952) 456-7000
(952) 456-7001
Mailing address
4200 DAHLBERG DR STE 300, GOLDEN VALLEY, MN 55422-4841
(952) 512-5600
(952) 512-5651
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10001749A
IN
363A00000X
Physician Assistant
Primary
12465
MN
Other
Enumeration date
08/28/2014
Last updated
07/21/2022
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