Individual
DOMONIQUE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
306 WALCOTT ST APT 1, PITTSBURGH, PA 15204-1348
(412) 390-8780
Mailing address
306 WALCOTT ST APT 1, PITTSBURGH, PA 15204-1348
(412) 390-8780
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
75323601
PA
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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