Shalom Tahnee Wilson, LPN
Licensed Practical Nurse in Rochester, NY. Individual provider (NPI-1).
NPI number1659900611
StatusActive
Last updated in NPPESApr 2, 2020
Details
- NPI
- 1659900611
- Entity type
- Individual (NPI-1)
- Name
- Mr. Shalom Tahnee Wilson
- Credential
- LPN
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 2, 2020
- Certification date
- Apr 2, 2020
- Last updated
- Apr 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 164W00000X | Licensed Practical Nurse | 337636 | NY | Yes |
Practice location
Shalomwilson36@gmail.Com118 Pine Street
Rochester, NY 14445
Phone 585-329-4306
Mailing address
Shalom Wilson118 Pine Street
Rochester, NY 14445
Phone 585-329-4306
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