Individual
WANDA YVETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
317 OFFICE SQUARE LN STE 201B, VIRGINIA BEACH, VA 23462-3663
(757) 502-8980
(757) 502-8989
Mailing address
317 OFFICE SQUARE LN STE 201B, VIRGINIA BEACH, VA 23462-3663
(757) 502-8980
(757) 502-8989
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823988446
—
VA
Enumeration date
02/23/2018
Last updated
09/13/2018
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