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1104646793
LACEY LEE WILSON
PHOENIX, AZ
NPI
1104646793
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: AZ 315636)
Enumeration Date
2024-10-16
Last Update Date
2024-10-16
Business Address
MISS LACEY LEE WILSON
4859 N 20TH ST
PHOENIX, AZ 85016-4707
Phone number: 602-669-3850
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Mailing Address
MISS LACEY LEE WILSON
735 E GARY LN
PHOENIX, AZ 85042-6647
Phone number: 602-814-2852
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