Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 16928 | AL |
NPI | 1114966694 |
---|---|
Provider Name | Felicia M. Wilson |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000087800 | (05) | AL |
00111185 | (05) | MS |
255633200 | (05) | FL |
36-10164 | UNITED HEALTH CARE (01) | AL |
51087800 | BLUE CROSS (01) | AL |
F41071 | (02) |