Individual
GLORIA ANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 243-4247
Mailing address
6309 MACK AVE, DETROIT, MI 48207-2302
(313) 243-4247
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704376927
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4704376927
—
MI
Enumeration date
12/21/2022
Last updated
09/28/2023
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