Healthcare Provider Details

I. General information

NPI: 1760767412
Provider Name (Legal Business Name): ANNALEE MARTHA WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 N MAYFAIR ST
SPOKANE WA
99208-1129
US

IV. Provider business mailing address

5428 E BRIDGEPORT CT
SPOKANE WA
99217-7867
US

V. Phone/Fax

Practice location:
  • Phone: 855-229-8012
  • Fax: 509-462-2275
Mailing address:
  • Phone: 509-981-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60249014
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1128A
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23519
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: