Individual
ALEXIS MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
790 PARK AVE, HUNTINGTON, NY 11743-4516
(843) 450-5591
Mailing address
11 SPARROW DR, CORAM, NY 11727-2707
(843) 450-5591
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/22/2025
Last updated
05/15/2025
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