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General NPI Number Information
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NPI Number | 1619234135
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Entity Type | Individual
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Provider Name | HANNAH ELIZABETH QUALLS WILSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/20/2012
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 790 CONCOURSE PKWY S STE 110
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City | MAITLAND
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State | FL
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Zip | 32751-6114
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Country | US
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Telephone | 407-253-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 790 CONCOURSE PKWY S STE 110
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City | MAITLAND
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State | FL
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Zip | 32751-6114
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Country | US
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Telephone | 407-253-1000
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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 | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | MD60960564
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License Number State | WA
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