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General NPI Number Information
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NPI Number | 1710403720
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Entity Type | Individual
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Provider Name | MRS. TWILA WILSON
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 5741 D IMBODEN STREET
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City | COLUMBIA
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State | SC
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Zip | 29206
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Country | US
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Telephone | 734-288-6644
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Fax | 803-708-0112
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Provider Business Mailing Address
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Address Line | 5741 IMBODEN ST APT D
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City | COLUMBIA
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State | SC
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Zip | 29206-5717
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Country | US
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Telephone |
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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