Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 17-1630 | AZ |
N | 175F00000X | Naturopath | NT60609291 | WA |
NPI | 1114385572 |
---|---|
Provider Name | Emilie Clasgens Wilson |
First Address | Prescott, AZ 86301-1164 |
Second Address | Prescott, AZ 86301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2016 |
Last Update Date | 24/09/2019 |