Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 38951 | KY |
NPI | 1013971431 |
---|---|
Provider Name | Dr. Heather Lynn Wilson |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40207-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6408377 | (05) | KY |
I03704 | (02) | |
P00983047 | MEDICARE RR (01) | KY |