Individual
SAMANTHA MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 632-5000
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
20180033371
MO
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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