Individual
AVA MICHELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(832) 314-2838
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 349-5200
(215) 615-3997
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/27/2023
Last updated
04/17/2023
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