Provider Demographics
NPI:1851915045
Name:WILSON, THOMASENE
Entity Type:Individual
Prefix:
First Name:THOMASENE
Middle Name:
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:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:SPRING HOPE
Mailing Address - State:NC
Mailing Address - Zip Code:27882-1690
Mailing Address - Country:US
Mailing Address - Phone:252-478-7426
Mailing Address - Fax:252-478-3713
Practice Address - Street 1:615 SAINT GEORGE SQUARE CT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1356
Practice Address - Country:US
Practice Address - Phone:252-478-7426
Practice Address - Fax:252-478-3713
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide