Provider Demographics
NPI:1477126472
Name:WILSON, MAGGIE SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:SUE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PANSY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-6403
Mailing Address - Country:US
Mailing Address - Phone:865-603-1543
Mailing Address - Fax:
Practice Address - Street 1:406 PANSY HILL RD
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-6403
Practice Address - Country:US
Practice Address - Phone:865-603-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000073091164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse