Provider Demographics
NPI:1427549617
Name:WILSON, TRACI DENISE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:DENISE
Last Name:WILSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7419 DRUMLEA RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3423
Mailing Address - Country:US
Mailing Address - Phone:240-351-0732
Mailing Address - Fax:
Practice Address - Street 1:7419 DRUMLEA RD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3423
Practice Address - Country:US
Practice Address - Phone:240-351-0732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1009308163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency