Individual
DAVAUNIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2208 19TH ST W, LEHIGH ACRES, FL 33971
(954) 675-3678
Mailing address
2208 19TH ST W, LEHIGH ACRES, FL 33971
(954) 675-3678
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5244230
FL
Other
Enumeration date
06/29/2023
Last updated
06/29/2023
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