Healthcare Provider Details

I. General information

NPI: 1326351818
Provider Name (Legal Business Name): APRIL RENA WILSON MLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 DAVID DR
MEMPHIS TN
38116-5606
US

IV. Provider business mailing address

1330 DAVID DR
MEMPHIS TN
38116-5606
US

V. Phone/Fax

Practice location:
  • Phone: 901-283-6036
  • Fax:
Mailing address:
  • Phone: 901-283-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberML0000022492
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: