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1124893151
DOMONIQUE SHANTEL WILSON
EAST LIVERPOOL, OH
NPI
1124893151
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: OH APRNCNP0035421)
Enumeration Date
2023-11-20
Last Update Date
2023-11-20
Business Address
DOMONIQUE SHANTEL WILSON PMHNP-BC
15613 PINEVIEW DR STE C
EAST LIVERPOOL, OH 43920-9096
Phone number: 330-932-1594
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Mailing Address
DOMONIQUE SHANTEL WILSON PMHNP-BC
1132 PENNSBURY BLVD
PITTSBURGH, PA 15205-1610
Phone number: 412-251-6004
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