Provider Demographics
NPI:1659503357
Name:WILSON, CATRINA LYNETTE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CATRINA
Middle Name:LYNETTE
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 1:3019 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2020
Mailing Address - Country:US
Mailing Address - Phone:601-543-7256
Mailing Address - Fax:601-426-3709
Practice Address - Street 1:3019 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2020
Practice Address - Country:US
Practice Address - Phone:601-543-7256
Practice Address - Fax:601-426-3709
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP305367164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse