Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 22579-020 | WI |
NPI | 1033389473 |
---|---|
Provider Name | Pamela Aird Wilson |
First Address | Madison, WI 53705-4429 |
Second Address | Madison, WI 53705-4429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2008 |
Last Update Date | 30/08/2011 |