Individual
BRANDY LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2781 OSBORN DR, LAKE HAVASU CITY, AZ 86406-8629
(928) 505-5552
Mailing address
418 N MOONLIGHT DR, PARKER, AZ 85344-4110
(702) 575-2982
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
273193
AZ
Other
Enumeration date
04/25/2025
Last updated
04/25/2025
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