Healthcare Provider Details

I. General information

NPI: 1629210489
Provider Name (Legal Business Name): RALPH WILSON N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 WISCONSIN AVE NW STE 100
WASHINGTON DC
20016-4136
US

IV. Provider business mailing address

5101 WISCONSIN AVE NW STE 100
WASHINGTON DC
20016-4136
US

V. Phone/Fax

Practice location:
  • Phone: 202-320-8665
  • Fax:
Mailing address:
  • Phone: 202-320-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-130
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: