Healthcare Provider Details

I. General information

NPI: 1437599180
Provider Name (Legal Business Name): BARBARA DENISE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 10/19/2024
Certification Date: 10/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 SUNSET BLVD # 2006
WEST COLUMBIA SC
29169-5914
US

IV. Provider business mailing address

1304 SUNSET BLVD # 2006
WEST COLUMBIA SC
29169-5914
US

V. Phone/Fax

Practice location:
  • Phone: 704-852-0835
  • Fax:
Mailing address:
  • Phone: 704-852-0835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: