Provider Demographics
NPI:1104828607
Name:WILSON, PAULA JEAN (APRN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 51G
Mailing Address - Street 2:
Mailing Address - City:JASONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47438-9801
Mailing Address - Country:US
Mailing Address - Phone:011-505-2664
Mailing Address - Fax:505-266-9941
Practice Address - Street 1:UNIT 2709 BOX 6
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:34021-2709
Practice Address - Country:US
Practice Address - Phone:505-266-4925
Practice Address - Fax:505-266-9941
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1002465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily