Individual
RAQUITA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6425 W 12TH ST, LITTLE ROCK, AR 72204-1509
(501) 666-8686
Mailing address
PO BOX 251970, LITTLE ROCK, AR 72225-1970
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
915732326
AR
Other
Enumeration date
08/22/2019
Last updated
08/22/2019
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