Provider Demographics
NPI:1184459745
Name:WILSON, GAIL MARIE (RN, BSN)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2664
Mailing Address - Country:US
Mailing Address - Phone:808-286-5878
Mailing Address - Fax:
Practice Address - Street 1:111 S DURBIN ST STE 200
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2557
Practice Address - Country:US
Practice Address - Phone:307-439-2033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY26791261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical