Provider Demographics
NPI:1598702748
Name:WILSON, ANNE LOUISE (NPM)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12423 SOUTH 87TH
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530
Mailing Address - Country:US
Mailing Address - Phone:251-987-1323
Mailing Address - Fax:251-947-1084
Practice Address - Street 1:1628 N MCKENZIE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2248
Practice Address - Country:US
Practice Address - Phone:251-947-1083
Practice Address - Fax:251-947-1084
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101751367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-31675OtherBC/BS