Individual
TYSHANNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
126 CALDERDALE LN, CHARLOTTE, NC 28262-2231
(203) 887-0625
Mailing address
126 CALDERDALE LN, CHARLOTTE, NC 28262-2231
(203) 887-0625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
344128
NC
Other
Enumeration date
04/23/2025
Last updated
04/23/2025
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