Individual
CYNTHIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 IXORIA AVE, FORT PIERCE, FL 34982-6250
(772) 468-3910
(772) 468-3979
Mailing address
404 IXORIA AVE, FORT PIERCE, FL 34982-6250
(772) 468-3910
(772) 468-3979
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154439958
—
FL
Enumeration date
11/19/2013
Last updated
11/19/2013
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