Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3300 | OK |
NPI | 1336168228 |
---|---|
Provider Name | Pamela L Wilson |
First Address | Norman, OK 73069-7641 |
Second Address | Norman, OK 73069-7641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 01/10/2018 |