Provider Demographics
NPI:1821136870
Name:WILSON, CHERYL MARIE (RN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX B
Mailing Address - Street 2:157 TWIN OAKS DRIVE
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394
Mailing Address - Country:US
Mailing Address - Phone:985-537-6823
Mailing Address - Fax:985-537-5519
Practice Address - Street 1:157 TWIN OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394
Practice Address - Country:US
Practice Address - Phone:985-537-6823
Practice Address - Fax:985-537-5519
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN039291163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent