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General NPI Number Information
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NPI Number | 1578230371
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Entity Type | Individual
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Provider Name | ANDREA MARIE WILSON CPM
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Gender | Female
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 852 MCCALLIE AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37403-2600
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Country | US
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Telephone | 920-460-7067
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Fax |
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Provider Business Mailing Address
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Address Line | 941 SIGNAL RD
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-3074
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Country | US
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Telephone | 920-460-7067
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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 | 176B00000X
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Taxonomy Name | Midwife
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License Number | 111
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License Number State | TN
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