Individual
ELIZABETH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1216 GRANBY ST STE 7, NORFOLK, VA 23510-2622
(757) 627-6600
(757) 627-6604
Mailing address
1216 GRANBY ST STE 7, NORFOLK, VA 23510-2622
(757) 627-6600
(757) 627-6604
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1497133870
—
VA
Enumeration date
05/12/2017
Last updated
05/12/2017
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