Individual
STEPHANIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
2701 CUMBERLAND RD, ODESSA, TX 79762-6913
(951) 413-9638
Mailing address
2701 CUMBERLAND RD, ODESSA, TX 79762-6913
(951) 413-9638
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
219438
TX
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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