Provider Demographics
NPI:1194260208
Name:WILSON, GARNER (PA)
Entity type:Individual
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First Name:GARNER
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1600 S 48TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1283
Mailing Address - Country:US
Mailing Address - Phone:402-483-3333
Mailing Address - Fax:402-486-3297
Practice Address - Street 1:1500 S 48TH ST
Practice Address - Street 2:STE 400
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1276
Practice Address - Country:US
Practice Address - Phone:402-483-3333
Practice Address - Fax:402-483-3297
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant