Provider Demographics
NPI:1447561535
Name:WILSON, ANNA BABAYAN (DO)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BABAYAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 NEAL ST STE A
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6705
Mailing Address - Country:US
Mailing Address - Phone:530-273-2720
Mailing Address - Fax:530-273-2770
Practice Address - Street 1:117 NEAL ST STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6705
Practice Address - Country:US
Practice Address - Phone:530-273-2720
Practice Address - Fax:530-273-2770
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A175642085R0202X
MI53150462102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology