Individual
JAYLEN KEYSAUN GREEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3663 E SUNSET RD STE 201C, LAS VEGAS, NV 89120-3246
(702) 930-5958
Mailing address
415 GIOCOSO CT, HENDERSON, NV 89011-5423
(702) 930-5958
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/28/2023
Last updated
07/28/2023
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