Doctor Name: | GINA G WILSON |
NPI Number: | 1073581047 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | APN562 |
Business Practice Address: | 1013 Professional Ct Manning, SC - 291022827 |
Business Phone Number: | 8034337444 |
Business Fax Number: | 8034337448 |
Mailing Address: | 1013 Professional Ct, MANNING |
State: | SC |
Postal Code: | 291022827 |
Phone Number: | 8034337444 |
Fax Number: | 8034337448 |
NPI Enumeration Date: | 03/08/2006 |
NPI Last Update Date: | 01/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN562 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |