Wanda Gayle Wilson
General Practice Physician
3559 Amazonas St
Jefferson City
, Missouri 65109
Wanda Gayle Wilson
General Practice Physician
3559 Amazonas St
Jefferson City
, Missouri 65109
(573) 893-1984
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Wanda Gayle Wilson
- 3559 Amazonas St Health Branch West
- Jefferson City, MO
- Zip : 65109
- Fax : (573) 893-1984
- Phone : (573) 893-7848
Second Address
- Wanda Gayle Wilson
- 3559 Amazonas St
- Jefferson City, MO
- Zip : 65109
- Fax : (573) 893-1984
- Phone : (573) 893-7848
Reviews
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Is Wanda Gayle Wilson a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | R8779 | MO |
National Provider Identifier
| NPI | 1033182118 |
|---|---|
| Provider Name | Wanda Gayle Wilson |
| First Address | Jefferson City, MO 65109 |
| Second Address | Jefferson City, MO 65109 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/02/2006 |
| Last Update Date | 30/06/2009 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 185418 | BCBS (01) | |
| 241488329 | (05) | MO |
| 251463 | HEALTHLINK (01) | |
| 829180 | FIRST HEALTH (01) | |
| 9183317004 | CIGNA (01) | |
| D41738 | (02) | |
| D41738 | MERCY (01) | |
| P00200365 | RR MEDICARE (01) |
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.