Search › Missouri › 122300000X
Shane Wilson
NPI 1780334664 · on the registry since 2022
Practice
- Address
- 110 Watson Cir
Gravois Mills, MO 65037 - Phone
- (763) 528-5539
Registry record
- Primary taxonomy
- 122300000X
122300000X
- Licence states on file
- MO
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2022-06-06
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Missouri