| NPI | 1740825603 |
|---|---|
| Former Name | ANITRA LA'TRICE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 0000000000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 98069) |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2024-09-13 |