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General NPI Number Information
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NPI Number | 1972303717
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Entity Type | Individual
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Provider Name | ALEX WILLIAM WILSON
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Gender | Male
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 1450 ALTA VISTA ST
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City | DUBUQUE
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State | IA
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Zip | 52001-4327
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Country | US
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Telephone | 309-373-9113
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Fax |
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Provider Business Mailing Address
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Address Line | 122 N 5TH AVE
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City | NEW WINDSOR
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State | IL
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Zip | 61465-9286
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Country | US
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Telephone | 309-373-9113
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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