Provider Demographics
NPI:1255370524
Name:WILSON, DENISE V (CRNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:V
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 1:957 NATIONAL HIGHWAY
Mailing Address - Street 2:STE 3
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:240-362-7128
Mailing Address - Fax:240-362-7129
Practice Address - Street 1:957 NATIONAL HWY STE 3
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7356
Practice Address - Country:US
Practice Address - Phone:240-362-7128
Practice Address - Fax:240-362-7129
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187329YDSJOtherMEDICARE-UNSPECIFIED
MD754LL498Medicare ID - Type UnspecifiedMEDICARE NUMBER
MDQ45567Medicare UPIN