Provider Demographics
NPI:1043561483
Name:WILSON, AMY L (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3405 FAIRVIEW AVE #6
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:MD
Mailing Address - Zip Code:73072-5047
Mailing Address - Country:US
Mailing Address - Phone:405-408-4845
Mailing Address - Fax:
Practice Address - Street 1:3110 HEALTHPLEX PARKWAY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-292-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0025911164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse