Provider Demographics
NPI:1982424974
Name:WILSON, SCOTT HILLSMAN (LAC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:HILLSMAN
Last Name:WILSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6709 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-3227
Mailing Address - Country:US
Mailing Address - Phone:520-465-6890
Mailing Address - Fax:
Practice Address - Street 1:1647 N ALVERNON WAY STE 3
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3361
Practice Address - Country:US
Practice Address - Phone:520-465-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist