Provider Demographics
NPI:1013805043
Name:WILSON, TERELL
Entity type:Individual
Prefix:
First Name:TERELL
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:CARTER LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51510-1443
Mailing Address - Country:US
Mailing Address - Phone:402-301-9851
Mailing Address - Fax:
Practice Address - Street 1:1412 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:CARTER LAKE
Practice Address - State:IA
Practice Address - Zip Code:51510-1443
Practice Address - Country:US
Practice Address - Phone:402-301-9851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant