Provider Demographics
NPI:1912223579
Name:WILSON, ANESTRA LATSHA (LPN)
Entity type:Individual
Prefix:MRS
First Name:ANESTRA
Middle Name:LATSHA
Last Name:WILSON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:ANESTRA
Other - Middle Name:LATSHA
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2544 W SUNLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4503
Mailing Address - Country:US
Mailing Address - Phone:216-288-9229
Mailing Address - Fax:
Practice Address - Street 1:2544 W SUNLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-4503
Practice Address - Country:US
Practice Address - Phone:216-288-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH398815163W00000X
AZRN214132163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty