Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 5501019427 | MI |
NPI | 1366034209 |
---|---|
Provider Name | Joyce Wilson |
First Address | Garden City, MI 48135-1821 |
Second Address | Garden City, MI 48135-1821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2021 |
Last Update Date | 10/02/2021 |