Individual
BRADLEY RUSSELL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 343-3660
Mailing address
36251 ALFRED ST, NEW BALTIMORE, MI 48047-2106
(586) 840-6016
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
470429662
MI
Other
Enumeration date
01/08/2019
Last updated
01/08/2019
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