Individual
CARLIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PRN, AGCNS-BC
Contact information
Practice address
19360 SHADYSIDE ST, LIVONIA, MI 48152-1319
(734) 678-7186
Mailing address
19360 SHADYSIDE ST, LIVONIA, MI 48152-1319
Taxonomy
Speciality
Code
Description
License number
State
364SG0600X
Gerontology Clinical Nurse Specialist
Primary
2021000750
MI
Other
Enumeration date
04/06/2021
Last updated
04/06/2021
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