Individual
LISA VIRGINIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1333 CHESTNUT AVE, LONG BEACH, CA 90813
(562) 753-2301
Mailing address
1333 CHESTNUT AVE, LONG BEACH, CA 90813-2944
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
95055716
CA
Other
Enumeration date
08/14/2017
Last updated
07/21/2022
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