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General NPI Number Information
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NPI Number | 1407931975
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Entity Type | Individual
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Provider Name | CHRISTINE B WILSON DO
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4 NEWTON AVE
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City | NORWICH
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State | NY
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Zip | 13815-1153
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Country | US
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Telephone | 607-337-4139
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211
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City | SO PLYMOUTH
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State | NY
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Zip | 13844-0211
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Country | US
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Telephone | 607-334-7825
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 177130
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License Number State | NY
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