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General NPI Number Information
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NPI Number | 1174577530
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Entity Type | Individual
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Provider Name | FRANK CLARK WILSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 S LINCOLN AVE
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City | LEBANON
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State | PA
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Zip | 17042-7529
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Country | US
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Telephone | 717-228-5969
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Fax | 712-228-5972
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Provider Business Mailing Address
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Address Line | 4307 KENTUCKY DR
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City | HARRISBURG
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State | PA
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Zip | 17112-9541
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Country | US
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Telephone | 717-657-8793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA 2026L
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License Number State | PA
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