Individual
SUSAN E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
616 SMITHVIEW DR, MARYVILLE, TN 37803-6100
(865) 379-2277
(865) 738-0087
Mailing address
616 SMITHVIEW DR, MARYVILLE, TN 37803-6100
(865) 379-2277
(865) 738-0087
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
APN12098
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20060525
BOARD CERTIFICATION #
TN
01
—
APN0000012098
ADVANCED PRACTICE ID #
TN
01
—
RN0000096921
RN STATE LICENSE
TN
Enumeration date
07/11/2006
Last updated
03/07/2023
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