Provider Demographics
NPI:1821677709
Name:WILSON TELEHEALTH PREVENTIVE CARE
Entity Type:Organization
Organization Name:WILSON TELEHEALTH PREVENTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN, MHA, CRRN
Authorized Official - Phone:704-974-9558
Mailing Address - Street 1:113 ADVENT DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:NC
Mailing Address - Zip Code:28073-8558
Mailing Address - Country:US
Mailing Address - Phone:704-974-9558
Mailing Address - Fax:
Practice Address - Street 1:113 ADVENT DR
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:NC
Practice Address - Zip Code:28073-8558
Practice Address - Country:US
Practice Address - Phone:704-974-9558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty