Individual
DELORA WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1133 COLOMA WAY STE C, ROSEVILLE, CA 95661-4480
(916) 774-6647
Mailing address
10540 REDBURN LN APT 3, RANCHO CORDOVA, CA 95670-4735
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
707209
CA
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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