Provider Demographics
NPI:1104648302
Name:WILSON, REEMEKA LASHA (MASTER OF SCIENCE)
Entity type:Individual
Prefix:MS
First Name:REEMEKA
Middle Name:LASHA
Last Name:WILSON
Suffix:
Gender:F
Credentials:MASTER OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5015
Mailing Address - Country:US
Mailing Address - Phone:850-865-7064
Mailing Address - Fax:850-833-7528
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5015
Practice Address - Country:US
Practice Address - Phone:850-865-7064
Practice Address - Fax:850-833-7528
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator