NPI 1003298571

Evan Jonathan Wilson, IDC

Practitioner Independent Duty Corpsman Yuma, AZ

Practice location

Address: 2989 East Arow St, Yuma, AZ 85365
Phone: (310) 408-7127
Mailing address: 1617 E Reilly St APT C, Yuma, AZ 85365-5659

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1003298571
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jun 2015
Record last updated: 16 Sep 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.