Healthcare Provider Details

I. General information

NPI: 1780945469
Provider Name (Legal Business Name): MARGOT VERONICA WILSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 W INA RD STE 123
TUCSON AZ
85704-1975
US

IV. Provider business mailing address

1648 W BLUE HORIZON ST
TUCSON AZ
85704-1445
US

V. Phone/Fax

Practice location:
  • Phone: 520-297-9813
  • Fax:
Mailing address:
  • Phone: 757-617-3850
  • Fax: 520-297-0705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024170754
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: