Provider Demographics
NPI:1700111309
Name:WILSON, TRINTELLA PERTEEN
Entity Type:Individual
Prefix:
First Name:TRINTELLA
Middle Name:PERTEEN
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 1:811 DEWALT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-5001
Mailing Address - Country:US
Mailing Address - Phone:713-835-1198
Mailing Address - Fax:
Practice Address - Street 1:814 BERRY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3308
Practice Address - Country:US
Practice Address - Phone:281-501-3000
Practice Address - Fax:281-974-5287
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health