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Contact Information

WANDA G WILSON, DO
3559 AMAZONAS ST
JEFFERSON CITY, MO65109
 Phone: 573-893-7848
 Fax: 573-893-1984
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
Indicates primary specialty

NPI Profile & details for WANDA G WILSON · (Female)

NPI Number 1033182118
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 02/09/2006
Last updated 06/30/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • MO License # R8779
  • MO Medicaid 241488329
  • Other 185418 BCBS
  • Other 9183317004 CIGNA
  • Other 829180 FIRST HEALTH
  • Other 251463 HEALTHLINK
  • Other D41738 MERCY
  • Other P00200365 RR MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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