Healthcare Provider Details

I. General information

NPI: 1568969871
Provider Name (Legal Business Name): RONNA LAO-WILSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

IV. Provider business mailing address

3325 RESEARCH WAY
CARSON CITY NV
89706-7913
US

V. Phone/Fax

Practice location:
  • Phone: 775-220-9902
  • Fax: 775-232-3510
Mailing address:
  • Phone: 702-220-9902
  • Fax: 702-323-5108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21437
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: