| Doctor Name: | MARY F WILSON |
| NPI Number: | 1063431708 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 470404192436 |
| Business Practice Address: | 14211 White Creek Ave Ne Cedar Springs, MI - 493198168 |
| Business Phone Number: | 6162526320 |
| Business Fax Number: | 6162526360 |
| Mailing Address: | 2122 Health Dr Sw, Suite 230 WYOMING |
| State: | MI |
| Postal Code: | 495199698 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 06/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 470404192436 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |