Individual
MICHELE MCNALLEY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 S CENTER AVE, MERRILL, WI 54452-3404
(405) 203-0749
Mailing address
601 S CENTER AVE, MERRILL, WI 54452-3404
(405) 203-0749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3503-23
WI
363A00000X
Physician Assistant
PA2066
OK
363A00000X
Physician Assistant
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3503-23
STATE OF WISCONSIN
WI
01
—
PA2066
STATE MEDICAL BOARD LICENSE
OK
Enumeration date
03/01/2012
Last updated
05/21/2024
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