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Individual

BEVERLY CECILE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
3817 MAIN ST, LORIS, SC 29569-3017
(843) 663-8000
Mailing address
PO BOX 547, LITTLE RIVER, SC 29566-0547
(843) 663-8000

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17916
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NP2188
SC
Enumeration date
09/21/2012
Last updated
03/31/2015
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