Individual
SHAWNTAVIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1417 BRAVEHEART LN, CHARLOTTE, NC 28216-5708
(704) 953-4131
Mailing address
1417 BRAVEHEART LN, CHARLOTTE, NC 28216-5708
(704) 953-4131
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Enumeration date
02/14/2014
Last updated
02/14/2014
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