Individual
DEVANESE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
18921 SUSSEX ST, DETROIT, MI 48235-2841
(313) 264-4197
Mailing address
28475 GREENFIELD RD STE 113, SOUTHFIELD, MI 48076-3034
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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