Individual
MARY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1540 LAKE LANSING RD STE G3, LANSING, MI 48912-3757
(517) 913-6692
Mailing address
1540 LAKE LANSING RD STE G3, LANSING, MI 48912-3757
(517) 913-6692
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704263547
MI
Other
Enumeration date
06/11/2019
Last updated
06/11/2019
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