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Individual

LATICIA WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2202 HARRISON ST APT 14, WICHITA FALLS, TX 76308-1359
(940) 613-4725
Mailing address
2202 HARRISON ST APT 14, WICHITA FALLS, TX 76308-1359
(940) 613-4725

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
336501
TX

Other

Enumeration date
09/18/2018
Last updated
09/18/2018
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