Provider Demographics
NPI:1205477320
Name:WILSON, MILDRED JOYCE
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:JOYCE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MILLS ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-8605
Mailing Address - Country:US
Mailing Address - Phone:251-743-4117
Mailing Address - Fax:
Practice Address - Street 1:121 MILLS ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-8605
Practice Address - Country:US
Practice Address - Phone:251-743-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider