Provider Demographics
NPI:1740894682
Name:WILSON, RHONDA K
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:K
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 E OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-6105
Mailing Address - Country:US
Mailing Address - Phone:580-540-5906
Mailing Address - Fax:
Practice Address - Street 1:1029 E OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-6105
Practice Address - Country:US
Practice Address - Phone:580-540-5906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator