Provider Demographics
NPI:1215417878
Name:WILSON, MARIA ELENA (NURSE)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 N INTERSTATE 35 APT 2105
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4621
Mailing Address - Country:US
Mailing Address - Phone:512-297-7620
Mailing Address - Fax:
Practice Address - Street 1:14301 N INTERSTATE 35 APT 2105
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4621
Practice Address - Country:US
Practice Address - Phone:512-297-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219959164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse