Provider Demographics
NPI:1841559689
Name:WILSON, HILLARY DAWN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:HILLARY
Middle Name:DAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 JACOBS HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLEHOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:16748-5118
Mailing Address - Country:US
Mailing Address - Phone:585-307-6253
Mailing Address - Fax:814-697-7626
Practice Address - Street 1:436 JACOBS HILL RD
Practice Address - Street 2:
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748-5118
Practice Address - Country:US
Practice Address - Phone:585-307-6253
Practice Address - Fax:814-697-7626
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10309943164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse