Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1-037745 | AL |
NPI | 1043609670 |
---|---|
Provider Name | Anne Tate Wilson |
First Address | Athens, AL 35611-2480 |
Second Address | Athens, AL 35611-2480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 23/01/2015 |