Wilson, Gwen

Wilson, Gwen is an individual health care provider with primary practice located at 2111 College Dr Rehoboth Mckinley Christian Health Care Services, Gallup NM 87301-5600. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wilson, Gwen can be contacted via phone (505) 863-1820.

Contact Information

Primary practice address
2111 College Dr Rehoboth Mckinley Christian Health Care Services Gallup NM 87301-5600
Phone: (505) 863-1820
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 88-PA-01 New Mexico

Profile Details

NPI number 1497727218
LBN Legal business name Wilson, Gwen
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497727218 NPPES
Arizona MEDICAID 326240
Arizona MEDICAID 00093518
Arizona Other 10002165
Arizona Other PROVP16800

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