Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife |
NPI | 1003158312 |
---|---|
Provider Name | Miss Danielle Renee Wilson |
First Address | Jacksonville, NC 28540-4756 |
Second Address | Jacksonville, NC 28540-4756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 09/06/2020 |