Individual
JACOBA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
266 SKIDMORE LN, SUTTON, WV 26601-9271
(304) 765-4400
Mailing address
266 SKIDMORE LN, SUTTON, WV 26601-9271
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
0000
WV
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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