Individual
LEO WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 PROSPECT AVE., FAIRVIEW, ND 59221
(701) 844-8840
Mailing address
P.O. BOX 101, FAIRVIEW, MT 59221
(701) 844-8840
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
11/06/2020
Last updated
11/06/2020
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