Provider Demographics
NPI:1205182748
Name:WILSON, CAROL LASHAE' (ANP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LASHAE'
Last Name:WILSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 EAST 5TH STREET
Mailing Address - Street 2:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICES
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-4353
Mailing Address - Country:US
Mailing Address - Phone:252-328-6841
Mailing Address - Fax:252-328-0462
Practice Address - Street 1:1001 EAST 5TH STREET
Practice Address - Street 2:EAST CAROLINA UNIVERSITY STUDENT HEALTH SERVICE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-328-6841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004987363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health