Individual
MOLLIE EVELYN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
5820 W GIRARD AVE, PHILADELPHIA, PA 19131-4850
(215) 205-7149
Mailing address
5820 W GIRARD AVE, PHILADELPHIA, PA 19131-4850
(215) 205-7149
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
SP012970
PA
Other
Enumeration date
07/18/2013
Last updated
07/18/2013
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