Individual
KISHA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3938 MASSEY RUN, RALEIGH, NC 27616-9747
(804) 647-5093
Mailing address
3938 MASSEY RUN, RALEIGH, NC 27616-9747
(804) 647-5093
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
235291
NC
Other
Enumeration date
07/27/2020
Last updated
07/27/2020
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