Provider Demographics
NPI:1619392271
Name:WILSON, MARVA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:MARVA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CANOE CT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5380
Mailing Address - Country:US
Mailing Address - Phone:757-292-6013
Mailing Address - Fax:
Practice Address - Street 1:8 CANOE CT
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-5380
Practice Address - Country:US
Practice Address - Phone:757-292-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001242266163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management