Wilson, Renee M
Wilson, Renee M is an individual health care provider with primary practice located at 1618 S Millenium Way Ste 100 , Meridian ID 83642-6457. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Wilson, Renee M can be contacted via phone (208) 884-3376.Contact Information
Primary practice address
1618 S Millenium Way Ste 100
Meridian ID 83642-6457
Phone: (208) 884-3376
Fax: (208) 884-0858
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA557 | Idaho |
Profile Details
| NPI number | 1215019534 |
|---|---|
| LBN Legal business name | Wilson, Renee M |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 19th, 2006 |
| Last updated | Aug 10th, 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 | 1215019534 | NPPES |
| Idaho | MEDICAID | 807233200 |
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