Healthcare Provider Details

I. General information

NPI: 1700792488
Provider Name (Legal Business Name): MARYAH WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 E 7TH ST
CHICO CA
95928-5999
US

IV. Provider business mailing address

75 FELICIDAD LN
CHICO CA
95973-9712
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-3000
  • Fax:
Mailing address:
  • Phone: 530-949-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95197725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: