Individual
KIA DANIELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2449 GOLF RD, PHILADELPHIA, PA 19131-1475
(305) 925-7731
Mailing address
747 N 40TH ST, PHILADELPHIA, PA 19104-1671
(215) 205-7628
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN278043
PA
Other
Enumeration date
05/26/2020
Last updated
05/26/2020
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