Individual
IVORY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 FIBERLOID ST, INDIAN ORCHARD, MA 01151-1006
(413) 381-6644
Mailing address
200 FIBERLOID ST, INDIAN ORCHARD, MA 01151-1006
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN96517
MA
Other
Enumeration date
03/18/2024
Last updated
03/18/2024
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