Provider Demographics
NPI:1659549673
Name:WILSON, LAUREEN MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:MARIE
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 1:110 MAIN ST
Mailing Address - Street 2:#310
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3509
Mailing Address - Country:US
Mailing Address - Phone:207-571-4842
Mailing Address - Fax:207-571-4842
Practice Address - Street 1:15 PIPER RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9473
Practice Address - Country:US
Practice Address - Phone:207-883-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPO11177164W00000X
NH010199-22164W00000X
MA34349164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse