Provider Demographics
NPI:1760767412
Name:WILSON, ANNALEE MARTHA (NP)
Entity type:Individual
Prefix:
First Name:ANNALEE
Middle Name:MARTHA
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5428 E BRIDGEPORT CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99217-7867
Mailing Address - Country:US
Mailing Address - Phone:509-981-3726
Mailing Address - Fax:
Practice Address - Street 1:6001 N MAYFAIR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1129
Practice Address - Country:US
Practice Address - Phone:855-229-8012
Practice Address - Fax:509-462-2275
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60249014363L00000X
IDNP-1128A363L00000X
ID23519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily