Individual
PATRICE LAVON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
30534 HENNIGAN ST, ROSEVILLE, MI 48066-1450
(313) 324-2300
Mailing address
30534 HENNIGAN ST, ROSEVILLE, MI 48066-1450
(313) 324-2300
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113331
MI
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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