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Individual

NEDRAE NICHELLE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
12501 HAMILTON AVE, HIGHLAND PARK, MI 48203-3243
(313) 865-1580
Mailing address
12501 HAMILTON AVE, HIGHLAND PARK, MI 48203-3243
(313) 865-1580

Taxonomy

Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
4704241724
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4704241724
MI
Enumeration date
09/06/2022
Last updated
09/06/2022
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