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Individual

MS. LORETTA K WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP

Contact information

Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
PO BOX 602658, WAKE FOREST UNIVERSITY HEALTH SCIENCES, CHARLOTTE, NC 28260-2658
(336) 716-2255
(336) 716-3202

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
900352
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1761X
BCBS
NC
01
1861450983
PARTNERS
NC
01
268270
MEDCOST
NC
01
3648339
UNITED HEALTHCARE
NC
01
4744420
AETNA
NC
01
P00654521
RAILROAD MEDICARE
NC
01
QNP211
SC MEDICAID
SC
Enumeration date
05/01/2006
Last updated
04/04/2014
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