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General NPI Number Information
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NPI Number | 1790773570
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Entity Type | Individual
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Provider Name | MARY ANNE WILSON ANP
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Gender | Female
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Dates
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Enumeration Date | 10/06/2005
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Last Update Date | 09/29/2009
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Provider Practice Location Address
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Address Line | 319 EAGLE RUN LOOP BOX 215
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City | SELDOVIA
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State | AK
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Zip | 99663-0215
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Country | US
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Telephone | 907-234-7510
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | SELDOVIA
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State | AK
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Zip | 99663-0215
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Country | US
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Telephone | 907-234-7510
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 08175-0038
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License Number State | AK
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