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Individual

CASSANDRA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
14121 PARKE LONG CT STE 201, CHANTILLY, VA 20151-1647
(312) 607-3905
Mailing address
210 CATALINA DR, NEWARK, DE 19711-6902
(312) 607-3905
(312) 801-9808

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
LG-0001162
DE
363LF0000X
Family Nurse Practitioner
Primary
209.016147
IL

Other

Enumeration date
07/24/2017
Last updated
02/04/2026
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