Individual
MS. LASONYA CAROL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5830 N 75TH ST, MILWAUKEE, WI 53218
(414) 614-7214
Mailing address
5830 N 75TH ST, MILWAUKEE, WI 53218
(414) 614-7214
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
306933-01
WI
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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