Provider Demographics
NPI:1013154004
Name:WILSON, LAURA DENISE SHAPIRO (CRNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DENISE SHAPIRO
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNP
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-1655
Mailing Address - Fax:239-424-1649
Practice Address - Street 1:1682 NE PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-1756
Practice Address - Country:US
Practice Address - Phone:239-424-1655
Practice Address - Fax:239-424-1649
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN562789163W00000X
PASP010096363L00000X
FLARNP9397265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022651500Medicaid