| NPI | 1205140951 |
|---|---|
| Former Name | SHANTEL D WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: UT 6858779-4405) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: UT 6858779-3102) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2025-07-22 |