Provider Demographics
NPI:1730102674
Name:WILTON, DARLA J (APRN)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:J
Last Name:WILTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-2097
Mailing Address - Country:US
Mailing Address - Phone:308-385-6252
Mailing Address - Fax:
Practice Address - Street 1:2300 W CAPITAL AVE
Practice Address - Street 2:GRAND ISLAND VETERANS HOME
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2097
Practice Address - Country:US
Practice Address - Phone:308-385-6252
Practice Address - Fax:308-385-6260
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47079417000Medicaid
NE38805OtherBLUE CROSS BLUE SHIELD
NE994.994OtherCOVENTRY
NE231749OtherMIDLANDS CHOICE
NE274096Medicare ID - Type Unspecified
NE231749OtherMIDLANDS CHOICE