Individual
SHANICE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
109 KNOX ABBOTT DR UNIT 2112, CAYCE, SC 29033-4410
(803) 406-0597
Mailing address
109 KNOX ABBOTT DR UNIT 2112, CAYCE, SC 29033-4410
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
240329
SC
Other
Enumeration date
12/15/2020
Last updated
12/15/2020
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