Individual
MICHELLE M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
19 LAKES ST, NESPELEM, WA 99155
(800) 416-7459
Mailing address
30 SHERLING AVE, JEFFERSON, LA 70121-2200
(504) 312-2534
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
RN156196
LA
Other
Enumeration date
04/15/2019
Last updated
04/15/2019
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