Wilson, Amanda Louise
Wilson, Amanda Louise is an individual health care provider with primary practice located at 4016 52Nd Avenue Ct Nw , Gig Harbor WA 98335-7632. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is her primary health care specialty. Wilson, Amanda Louise can be contacted via phone (413) 221-6113.Contact Information
Primary practice address
4016 52Nd Avenue Ct Nw
Gig Harbor WA 98335-7632
Phone: (413) 221-6113
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 205246 | Massachusetts |
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 049592 | Connecticut |
Allopathic & Osteopathic Physicians / Addiction Medicine | 207RA0401X | 4301505786 | Michigan |
Allopathic & Osteopathic Physicians / Addiction Medicine | 207RA0401X | 60935430 | Washington |
Profile Details
NPI number | 1821066085 |
---|---|
LBN Legal business name | Wilson, Amanda Louise |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 14th, 2006 |
Last updated | May 3rd, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1821066085 | NPPES |
Massachusetts | MEDICAID | 0126748 | |
Massachusetts | MEDICAID | 003126944 |
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