Provider Demographics
NPI:1336779370
Name:WILSON, SHARON LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RILLIA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-5042
Mailing Address - Country:US
Mailing Address - Phone:205-269-2775
Mailing Address - Fax:
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8999
Practice Address - Country:US
Practice Address - Phone:256-772-8108
Practice Address - Fax:256-772-9703
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based