Individual
MISS SHANNA RAE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
480 GALLETTI WAY # 8C, SPARKS, NV 89431-5564
(775) 324-1490
(775) 324-1541
Mailing address
480 GALLETTI WAY #8C, SPARKS, NV 89431-5564
(775) 324-1490
(775) 324-1541
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
09/21/2010
Last updated
09/21/2010
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