Individual
MS. WHITNEY D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26483 EVANGELINE TRACE BLVD, DENHAM SPRINGS, LA 70726-6174
(225) 503-5731
Mailing address
26483 EVANGELINE TRACE BLVD, DENHAM SPRINGS, LA 70726-6174
(225) 202-2650
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
008763932
LA
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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