Individual
FAYETTA RENEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
929 SIMON DR, CEDAR HILL, TX 75104-7203
(972) 821-3159
Mailing address
929 SIMON DR, CEDAR HILL, TX 75104-7203
(972) 821-3159
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
949697
TX
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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