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General NPI Number Information
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NPI Number | 1548590839
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Entity Type | Individual
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Provider Name | SANTANA M WILSON LATC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 01/08/2010
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Provider Practice Location Address
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Address Line | 275 BATH RD
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City | BRUNSWICK
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State | ME
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Zip | 04011-2671
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Country | US
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Telephone | 207-729-4998
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Fax | 207-729-6225
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Provider Business Mailing Address
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Address Line | 26A GARDEN ST
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City | BATH
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State | ME
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Zip | 04530-2620
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Country | US
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Telephone | 207-381-7941
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Fax | 207-729-6225
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT363
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License Number State | ME
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