Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 8809951-1205 | UT |
NPI | 1255698726 |
---|---|
Provider Name | Carey A. Wilson |
First Address | Syracuse, NY 13202-2292 |
Second Address | Salt Lake City, UT 84113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2012 |
Last Update Date | 20/12/2021 |