Provider Demographics
NPI:1568515773
Name:WILSON, TERESA D (RN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71496-1526
Mailing Address - Country:US
Mailing Address - Phone:337-238-6431
Mailing Address - Fax:337-238-7070
Practice Address - Street 1:105 BELVIEW RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2902
Practice Address - Country:US
Practice Address - Phone:337-238-6431
Practice Address - Fax:337-238-7070
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN103870163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health