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General NPI Number Information
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NPI Number | 1720200058
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Entity Type | Individual
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Provider Name | WILLIAM M WILSON RN
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1215 NW 25TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-5629
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Country | US
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Telephone | 405-525-2525
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Fax | 405-525-3108
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Provider Business Mailing Address
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Address Line | 700 NW 17TH ST APT 10
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-2129
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Country | US
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Telephone | 405-525-2525
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | R0080272
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License Number State | OK
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