Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1053810184 |
---|---|
Provider Name | Heidi Katherine Wilson |
First Address | Sacramento, CA 95825-3221 |
Second Address | Sacramento, CA 95825-3221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 13/12/2019 |