| Doctor Name: | MS. E JOAN WILSON |
| NPI Number: | 1043479330 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CLS |
| License Number: | 9905528 |
| Business Practice Address: | 12000 Stone Lake Road Dulce, NM - 87528 |
| Business Phone Number: | 5057597238 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1403, OCEAN PARK |
| State: | WA |
| Postal Code: | 98640 |
| Phone Number: | 3606654599 |
| Fax Number: | |
| NPI Enumeration Date: | 06/03/2008 |
| NPI Last Update Date: | 06/04/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246ZI1000X |
| License Number: | 9905528 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | Illustration, Medical |
| Taxonomy Definition: | |