Provider Demographics
NPI:1629514963
Name:WILSON, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
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 1:7960 TERRACE ROCK WAY
Mailing Address - Street 2:UNIT 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3940
Mailing Address - Country:US
Mailing Address - Phone:702-432-6463
Mailing Address - Fax:702-432-6464
Practice Address - Street 1:3670 N RANCHO DR
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3174
Practice Address - Country:US
Practice Address - Phone:702-432-6463
Practice Address - Fax:702-432-6464
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor