Provider Information for 1386611168
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BRENDA MARIE WILSON M.S.
Sex: Female
NPI: 1386611168
Last Updated: 2022-07-21
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1386611168 | ||||||||||||||||
| Enumeration Date | 2006-03-01 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 12009 133RD ST E PUYALLUP, WA 98374-4698 United States Phone: 253-845-3028 | Fax: | ||||||||||||||||
| Primary Practice Address | 12009 133RD ST E PUYALLUP, WA 98374-4698 United States Phone: 253-845-3028 | Fax: | ||||||||||||||||
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