Provider Demographics
NPI:1477126472
Name:WILSON, MAGGIE SUE (LPN)
Entity type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:SUE
Last Name:WILSON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5608
Mailing Address - Country:US
Mailing Address - Phone:865-603-1543
Mailing Address - Fax:
Practice Address - Street 1:137 GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5608
Practice Address - Country:US
Practice Address - Phone:865-603-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000073091164W00000X
TN283776163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse