Healthcare Provider Details

I. General information

NPI: 1184459745
Provider Name (Legal Business Name): GAIL MARIE WILSON RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S DURBIN ST STE 200
CASPER WY
82601-2557
US

IV. Provider business mailing address

6410 COMANCHE DR
CHEYENNE WY
82009-2664
US

V. Phone/Fax

Practice location:
  • Phone: 307-439-2033
  • Fax:
Mailing address:
  • Phone: 808-286-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number26791
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: