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General NPI Number Information
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NPI Number | 1487569109
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Entity Type | Individual
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Provider Name | DANA MARIE WILSON CSFA
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Gender | Female
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Dates
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Enumeration Date | 08/17/2026
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Last Update Date | 08/17/2026
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Provider Practice Location Address
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Address Line | 8552 N GOVERNMENT WAY
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City | HAYDEN
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State | ID
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Zip | 83835-9280
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Country | US
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Telephone | 208-772-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 712 N MONROE AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-2114
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Country | US
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Telephone | 208-627-7437
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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