Provider Demographics
NPI:1518378009
Name:JEFFERSON WILSON, WANDA N (APRN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:WANDA
Middle Name:N
Last Name:JEFFERSON WILSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:154 HIGHWAY 1008
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390
Mailing Address - Country:US
Mailing Address - Phone:985-369-1880
Mailing Address - Fax:985-369-9191
Practice Address - Street 1:154 HIGHWAY 1008
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390
Practice Address - Country:US
Practice Address - Phone:985-369-1880
Practice Address - Fax:985-369-9191
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily