Individual
CAROLYN LORRAINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
349 NW 30TH AVE, FT LAUDERDALE, FL 33311-8427
(954) 696-6243
Mailing address
349 NW 30TH AVE, FT LAUDERDALE, FL 33311-8427
(954) 696-6243
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
3332772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3332772
REGISTERED NURSE
FL
Enumeration date
03/10/2019
Last updated
03/10/2019
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