Provider Demographics
NPI:1538138854
Name:WILSON, DONNA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
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 1:3863 N HUMBOLDT BLVD
Mailing Address - Street 2:APT. 10
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-1326
Mailing Address - Country:US
Mailing Address - Phone:414-967-0555
Mailing Address - Fax:
Practice Address - Street 1:5650 N 97TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-2502
Practice Address - Country:US
Practice Address - Phone:414-535-1362
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32851-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38327300OtherPROVIDER NUMBER