| NPI | 1174059919 |
|---|---|
| Former Name | SHANEQUA WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: NY 403688-01) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: NY 341543) |
| 363LF0000X Nurse Practitioner Family (Licence: NY 341543) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-11-04 |