Provider Demographics
NPI:1548380785
Name:WILSON, SHARON (RMF)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 OWEN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3455
Mailing Address - Country:US
Mailing Address - Phone:910-484-2645
Mailing Address - Fax:918-484-0866
Practice Address - Street 1:1840 OWEN DR STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3455
Practice Address - Country:US
Practice Address - Phone:910-484-2645
Practice Address - Fax:918-484-0866
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795144Medicaid