Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 246 | CT |
NPI | 1073700282 |
---|---|
Provider Name | Dr. Donielle K Wilson |
First Address | Chester, NY 10918-1102 |
Second Address | Riverside, CT 06878-1429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 02/10/2007 |