Individual
ANTINIQUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1104 BUCHANAN RD STE C10, ANTIOCH, CA 94509-4226
(925) 676-0505
Mailing address
2420 SAND CREEK RD # 130, BRENTWOOD, CA 94513-2707
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95025241
CA
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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