Provider Demographics
NPI:1528756921
Name:WILSON, REBECCA LYNN (MEDECSE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MEDECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 W FIREWEED LN, SUITE 280
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-350-4290
Mailing Address - Fax:
Practice Address - Street 1:171 W FIREWEED LN, SUITE 280
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-350-4290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist