Individual
VENESSA NACOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7819 BLUEBONNET BLVD STE C, BATON ROUGE, LA 70810-2836
(225) 335-8652
Mailing address
7819 BLUEBONNET BLVD STE C, BATON ROUGE, LA 70810-2836
(225) 335-8652
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
419152
LA
Other
Enumeration date
01/30/2023
Last updated
01/30/2023
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