Individual
SIMONE THERESE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
457 BELGRADE ST, PHILADELPHIA, PA 19125-2624
(828) 553-6832
Mailing address
PO BOX 29277, PHILADELPHIA, PA 19125-0977
(828) 553-6832
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86096718
NY
Other
Enumeration date
09/18/2019
Last updated
09/18/2019
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