Provider Demographics
NPI:1225368574
Name:WILSON, C. CHYLENE
Entity Type:Individual
Prefix:MRS
First Name:C.
Middle Name:CHYLENE
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 1:415 W LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7095
Mailing Address - Country:US
Mailing Address - Phone:480-776-9925
Mailing Address - Fax:
Practice Address - Street 1:415 W LONGHORN DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-7095
Practice Address - Country:US
Practice Address - Phone:480-776-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula