Individual
TIFFANY A WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
4800 MEMORIAL DR, WACO, TX 76711-1329
(254) 297-3000
Mailing address
3925 RICHFIELD AVE, WACO, TX 76707-1659
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
202615
TX
Other
Enumeration date
02/12/2020
Last updated
02/12/2020
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