Individual
CHANEL LENISE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19501 MONTEREY AVE, EUCLID, OH 44119-1506
(216) 338-1315
Mailing address
19501 MONTEREY AVE, EUCLID, OH 44119-1506
(216) 338-1315
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN.118035-IV
OH
Other
Enumeration date
02/12/2009
Last updated
02/12/2009
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