Provider Demographics
NPI:1720644008
Name:WILSON, ARIEL SHANTRICE
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:SHANTRICE
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 1:143 HICKORY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35217-1349
Mailing Address - Country:US
Mailing Address - Phone:205-451-3665
Mailing Address - Fax:
Practice Address - Street 1:143 HICKORY GROVE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35217-1349
Practice Address - Country:US
Practice Address - Phone:205-451-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide