Provider Demographics
NPI:1780823161
Name:WILSON, COURTNEY ELLER
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ELLER
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 S GLENN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-8004
Mailing Address - Country:US
Mailing Address - Phone:704-313-7340
Mailing Address - Fax:
Practice Address - Street 1:114 S GLENN DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-8004
Practice Address - Country:US
Practice Address - Phone:704-313-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2008475171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter