Provider Demographics
NPI:1174005367
Name:WILSON, ANNMARIE VALENTINE (NP)
Entity Type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:VALENTINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 ROAD 33
Mailing Address - Street 2:
Mailing Address - City:LINGLE
Mailing Address - State:WY
Mailing Address - Zip Code:82223-8519
Mailing Address - Country:US
Mailing Address - Phone:307-575-7103
Mailing Address - Fax:
Practice Address - Street 1:625 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1530
Practice Address - Country:US
Practice Address - Phone:307-532-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY41933.1823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily