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General NPI Number Information
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NPI Number | 1952304636
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Entity Type | Individual
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Provider Name | MEGAN E WILSON DNP
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Gender | Female
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 701 LEWISTON ST
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City | COTTONWOOD
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State | ID
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Zip | 83522-9750
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Country | US
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Telephone | 208-962-3267
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Fax | 208-962-2313
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Provider Business Mailing Address
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Address Line | 2003 KOOTENAI HEALTH WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-6051
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Country | US
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Telephone | 208-962-3251
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Fax | 208-962-2313
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP465A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP465A
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License Number State | ID
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