Doctor Name: | GRACE AGNES WILSON |
NPI Number: | 1467698506 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CSAC |
License Number: | |
Business Practice Address: | 575 East 100 South Price, UT - 84501 |
Business Phone Number: | 4356372358 |
Business Fax Number: | 4356379141 |
Mailing Address: | P.o. Box 867, 105 West 100 North PRICE |
State: | UT |
Postal Code: | 84501 |
Phone Number: | 4356377200 |
Fax Number: | 4356372377 |
NPI Enumeration Date: | 12/19/2008 |
NPI Last Update Date: | 12/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |