Individual
BRIAN A WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12801 BROOKHURST ST UNIT 1118, GARDEN GROVE, CA 92840-4864
(843) 214-5783
Mailing address
12801 BROOKHURST ST UNIT 1118, GARDEN GROVE, CA 92840-4864
(843) 214-5783
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95205412
CA
Other
Enumeration date
12/31/2019
Last updated
12/31/2019
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