Wilson, Gina Lynne

Wilson, Gina Lynne is an individual health care provider with primary practice located at 1501 Kings Hwy , Shreveport LA 71103-4228. She recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as her primary health care specialty. Wilson, Gina Lynne can be contacted via phone (318) 626-0800.

Contact Information

Primary practice address
1501 Kings Hwy Shreveport LA 71103-4228
Phone: (318) 626-0800
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD201912 Louisiana

Profile Details

NPI number 1215908496
LBN Legal business name Wilson, Gina Lynne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 27th, 2006
Last updated May 4th, 2018 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215908496 NPPES
Indiana MEDICAID 200199880

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