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Individual

DENISE V WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
957 NATIONAL HWY STE 3, LAVALE, MD 21502-7356
(240) 362-7128
(240) 362-7129
Mailing address
957 NATIONAL HIGHWAY, STE 3, LAVALE, MD 21502
(240) 362-7128
(240) 362-7129

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R137604
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
187329YDSJ
MEDICARE-UNSPECIFIED
MD
Enumeration date
06/05/2006
Last updated
07/12/2017
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