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General NPI Number Information
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NPI Number | 1790245801
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Entity Type | Individual
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Provider Name | BRIDGET ELISE WILSON MD
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Gender | Female
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Dates
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Enumeration Date | 03/23/2019
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE # R3
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City | CLEVELAND
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State | OH
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Zip | 44195-4502
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Country | US
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Telephone | 216-444-9410
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Fax | 216-442-5975
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Provider Business Mailing Address
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Address Line | 5777 E MAYO BLVD
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City | PHOENIX
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State | AZ
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Zip | 85054-4502
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Country | US
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Telephone | 480-301-8000
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 65897
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 35.150471
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License Number State | OH
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