Individual
LACEY PATRICIA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(248) 471-8000
Mailing address
28050 GRAND RIVER AVE, FARMINGTON HILLS, MI 48336-5919
(734) 218-1249
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704245031
MI
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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