Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 887086 | TX |
NPI | 1124665526 |
---|---|
Provider Name | Priscilla Wilson |
First Address | Midland, TX 79706-3166 |
Second Address | Midland, TX 79706-3166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |