Individual
MRS. THERESA RUSS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
201 GOVERNMENT CIR, GREENVILLE, NC 27834-8198
(252) 902-2349
Mailing address
3105 TUCKER DR, GREENVILLE, NC 27858-6017
(252) 353-2427
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
098763
NC
Other
Enumeration date
12/29/2006
Last updated
07/08/2007
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