Provider Demographics
NPI:1659925444
Name:WILSON, BERNICE
Entity Type:Individual
Prefix:
First Name:BERNICE
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 1:3210 W CHARLESTON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-0080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:702-369-3334
Practice Address - Street 1:3210 W CHARLESTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-0080
Practice Address - Country:US
Practice Address - Phone:702-893-2001
Practice Address - Fax:702-369-3334
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant