Individual
MR. ANDREO WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
161 ROSE LN, DRAKES BRANCH, VA 23937-2508
(434) 515-1805
Mailing address
161 ROSE LN, DRAKES BRANCH, VA 23937-2508
(434) 515-1805
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017448820001
—
VA
05
—
30017448820002
—
VA
Enumeration date
05/09/2022
Last updated
01/21/2023
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