Individual
MISS ALISA LANORA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
58 AVALON CIR, SMITHTOWN, NY 11787-3855
(516) 476-4284
(516) 997-5336
Mailing address
58 AVALON CIR, SMITHTOWN, NY 11787-3855
(516) 476-4284
(516) 997-5336
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
336632
NY
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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