Individual
VICTORIA NICHOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1409 JACQUALINE STREET, LOGANSPORT, LA 71049
(318) 575-9018
Mailing address
PO BOX 1041, LOGANSPORT, LA 71049-1041
(318) 575-9018
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3247
—
LA
Enumeration date
12/30/2021
Last updated
12/30/2021
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