# MRS. LAURA RENAE WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1104032218
- **Gender:** F
- **Credential:** MSN, APRN-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | 004365 | CT | — |
| 363LF0000X | Family Nurse Practitioner | 701633 | TX | — |
| 363LP2300X | Primary Care Nurse Practitioner | RN247115 | GA | Yes |

## Other

- **Enumeration date:** 05/15/2007
- **Last updated:** 03/06/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1275620551 | NPI - ROBERTSON COUNTY CHC | TX |
| 05 | — | 154467803 | — | TX |
| 01 | — | 1649265646 | NPI- BRYAN- COLLEGE STATION CHC | TX |
| 01 | — | 1821185299 | NPI - BVCAA | TX |