Provider Demographics
NPI:1972107696
Name:WILSON, ERLYN N
Entity type:Individual
Prefix:MS
First Name:ERLYN
Middle Name:N
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 1:615 S SAGINAW ST STE 3009
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1505
Mailing Address - Country:US
Mailing Address - Phone:810-627-8192
Mailing Address - Fax:
Practice Address - Street 1:615 S SAGINAW ST STE 3009
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1505
Practice Address - Country:US
Practice Address - Phone:810-627-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251V00000XAgenciesVoluntary or Charitable
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion