Provider Demographics
NPI:1114585650
Name:ANTOINE-WILSON, YVONNE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:ELIZABETH
Last Name:ANTOINE-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 1:936 N BON MARCHE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-2257
Mailing Address - Country:US
Mailing Address - Phone:225-478-9533
Mailing Address - Fax:225-478-9534
Practice Address - Street 1:936 N BON MARCHE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-2257
Practice Address - Country:US
Practice Address - Phone:225-478-9533
Practice Address - Fax:225-478-9534
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator