Individual
TYRONE NATHANIEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSN., LPN
Contact information
Practice address
16 SUMMER VALE CT, COLUMBIA, SC 29223-7861
(803) 331-8518
Mailing address
16 SUMMER VALE CT, COLUMBIA, SC 29223-7861
(803) 331-8518
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
34333
SC
Other
Enumeration date
11/09/2007
Last updated
11/09/2007
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