Provider Demographics
NPI:1548538291
Name:WILSON, ANGELA F
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:F
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 1:3812 VICK CIR
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2736
Mailing Address - Country:US
Mailing Address - Phone:405-590-7354
Mailing Address - Fax:
Practice Address - Street 1:3812 VICK CIR
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2736
Practice Address - Country:US
Practice Address - Phone:405-590-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker