Individual
CHANTAL TANISHA MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
765 VOSE AVE, APT B10, ORANGE, NJ 07050-1060
(973) 943-3728
Mailing address
765 VOSE AVE, APT B10, ORANGE, NJ 07050-1060
(973) 943-3728
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
670331
NY
Other
Enumeration date
08/21/2013
Last updated
08/21/2013
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