Individual
ELSA CHANTILE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6016 S 66TH EAST AVE, TULSA, OK 74145-9210
(918) 764-9098
Mailing address
454 S INDIANAPOLIS AVE, TULSA, OK 74112-2626
(509) 638-9294
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
OK
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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