Provider Demographics
NPI:1992326441
Name:WILSON, CHRISTOPHER SHANE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SHANE
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 NW 71ST ST
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6607
Mailing Address - Country:US
Mailing Address - Phone:405-255-9594
Mailing Address - Fax:
Practice Address - Street 1:5800 NW 71ST ST
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6607
Practice Address - Country:US
Practice Address - Phone:405-255-9594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist