Provider Demographics
NPI:1003291147
Name:WILSON, LINDSEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COBURG RD STE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7487
Mailing Address - Country:US
Mailing Address - Phone:541-687-8581
Mailing Address - Fax:541-343-1411
Practice Address - Street 1:10 COBURG RD STE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7487
Practice Address - Country:US
Practice Address - Phone:541-687-8581
Practice Address - Fax:541-343-1411
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9296007363LF0000X
OR201707978NP-PP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily