Provider Demographics
NPI:1770016123
Name:WILSON, LOIS (RN 9295661)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN 9295661
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 2274
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2274
Mailing Address - Country:US
Mailing Address - Phone:407-758-2302
Mailing Address - Fax:
Practice Address - Street 1:6100 STEVENSON DR
Practice Address - Street 2:UNIT 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2432
Practice Address - Country:US
Practice Address - Phone:407-758-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9295661163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse