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Individual

ALICE L WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
4266 W MAIN ST STE 101, GRAY, LA 70359-6421
(985) 713-2747
Mailing address
PO BOX 1264, GRAY, LA 70359-1264
(985) 713-2747

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20100410
LA

Other

Enumeration date
01/03/2024
Last updated
01/03/2024
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