Provider Demographics
NPI:1386008423
Name:WILSON, CILANTAY R (APRN)
Entity Type:Individual
Prefix:
First Name:CILANTAY
Middle Name:R
Last Name:WILSON
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Gender:F
Credentials:APRN
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Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:AGAPE SENIOR PRIMARY CARE INC DBA LTC HEALTH SOLUTIONS
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:1053 CENTER STREET
Practice Address - Street 2:DBA LTC HEALTH SOLUTIONS
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:843-353-2581
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2018-05-01
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Provider Licenses
StateLicense IDTaxonomies
SC20079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily