Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | BB4745785-2005013504 | MO |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 2011000670 | MO |
NPI | 1093925703 |
---|---|
Provider Name | Joyce Marie Wilson |
First Address | Jefferson City, MO 65110-4240 |
Second Address | Jefferson City, MO 65109-6003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 29/09/2021 |