Individual
ANTONIA C WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12530 VINE MAPLE DR SW, LAKEWOOD, WA 98499-1134
(253) 301-0099
Mailing address
12530 VINE MAPLE DR SW, LAKEWOOD, WA 98499-1134
(253) 301-0099
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN00161723
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2107449
—
WA
Enumeration date
12/02/2018
Last updated
12/02/2018
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