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General NPI Number Information
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NPI Number | 1033732912
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Entity Type | Individual
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Provider Name | KIA DANIELLE WILSON LPN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 2449 GOLF RD
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1475
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Country | US
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Telephone | 305-925-7731
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Fax |
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Provider Business Mailing Address
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Address Line | 747 N 40TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-1671
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Country | US
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Telephone | 215-205-7628
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN278043
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License Number State | PA
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