Individual
TRACY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
480 CENTRAL AVE, PEARL HARBOR, HI 96860-4908
(808) 471-1866
Mailing address
2370 POND RD, KAILUA, HI 96734-4842
(817) 808-7875
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN-17153
HI
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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