Provider Demographics
NPI:1497765432
Name:WILSON, SUNDAY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:SUNDAY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-9410
Mailing Address - Country:US
Mailing Address - Phone:806-472-3400
Mailing Address - Fax:
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-775-8607
Practice Address - Fax:806-775-8611
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN648049146D00000X
TXAP113755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant