Individual
SEAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2130 PINEHURST AVE, CHARLESTON, SC 29414-6455
(843) 763-1538
Mailing address
479 BLUE DRAGONFLY DR, CHARLESTON, SC 29414-9124
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
249922
SC
Other
Enumeration date
02/25/2020
Last updated
02/25/2020
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