| NPI | 1174993026 |
|---|---|
| Former Name | LATANYA NIKKOLE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN188640) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 201609584NP-PP) |
| 363L00000X Nurse Practitioner (Licence: GA RN 188640) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: VA 0024176026) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60726772) | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2021-05-03 |