Doctor Name: | MS. STELLA ELIZABETH WILSON |
NPI Number: | 1891085262 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.T. |
License Number: | TN 26432 |
Business Practice Address: | 500 Stone Lake Road Dulce, NM - 87528 |
Business Phone Number: | 5757597309 |
Business Fax Number: | 5757597294 |
Mailing Address: | 500 Stone Lake Road, DULCE |
State: | NM |
Postal Code: | 87528 |
Phone Number: | 5757597309 |
Fax Number: | 5757597294 |
NPI Enumeration Date: | 04/19/2011 |
NPI Last Update Date: | 06/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246QM0706X |
License Number: | TN 26432 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Spec/Tech, Pathology |
Taxonomy Specialization: | Medical Technologist |
Taxonomy Definition: |