Mr. Glenn Gordon Wilson
Prosthetist
514 S Washington St
Spokane
, Washington 99204-2620
Mr. Glenn Gordon Wilson
Prosthetist
514 S Washington St
Spokane
, Washington 99204-2620
(406) 750-0123
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About
Features
Specialties
- Prosthetist
Languages spoken
- English
Location
First Address
- Mr. Glenn Gordon Wilson
- 4214 S Sullivan Rd
- Veradale, WA
- Zip : 99037-9187
- Phone : (406) 750-0123
Second Address
- Mr. Glenn Gordon Wilson
- 514 S Washington St
- Spokane, WA
- Zip : 99204-2620
- Fax : (509) 787-0952
- Phone : (509) 624-3314
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 224P00000X | Prosthetist | PS60602304 | WA |
National Provider Identifier
| NPI | 1417471426 |
|---|---|
| Provider Name | Mr. Glenn Gordon Wilson |
| First Address | Veradale, WA 99037-9187 |
| Second Address | Spokane, WA 99204-2620 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 01/08/2017 |
| Last Update Date | 01/08/2017 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.