Nicholas Robert Wilson, MD
Internal Medicine in Saint Paul, MN. Individual provider (NPI-1).
NPI number1083177638
StatusActive
Last updated in NPPESApr 20, 2022
Details
- NPI
- 1083177638
- Entity type
- Individual (NPI-1)
- Name
- Nicholas Robert Wilson
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 10, 2019
- Certification date
- Apr 20, 2022
- Last updated
- Apr 20, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 70945 | MN | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
640 Jackson StSaint Paul, MN 55101-2502
Phone 651-254-3456
Mailing address
420 Delaware Street SeMmc 284
Minneapolis, MN 55455
Phone 612-626-5454
Other practice locations
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