Provider Demographics
NPI:1285800219
Name:WILSON, CHRISTINA ANN (MSOM)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 W SCOTT PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-1329
Mailing Address - Country:US
Mailing Address - Phone:303-477-9256
Mailing Address - Fax:
Practice Address - Street 1:3331 W SCOTT PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-1329
Practice Address - Country:US
Practice Address - Phone:303-477-9256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist