Provider Demographics
NPI:1619594876
Name:WILSON, DIONIA LARAINE
Entity Type:Individual
Prefix:
First Name:DIONIA
Middle Name:LARAINE
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 1:548 CONSTITUTION CIR
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-1008
Mailing Address - Country:US
Mailing Address - Phone:724-506-0071
Mailing Address - Fax:
Practice Address - Street 1:548 CONSTITUTION CIR
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-1008
Practice Address - Country:US
Practice Address - Phone:724-506-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker