Provider Demographics
NPI:1669803763
Name:WILSON, SHEILA
Entity type:Individual
Prefix:MISS
First Name:SHEILA
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 1:4466 ELVIS PRESLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7180
Mailing Address - Country:US
Mailing Address - Phone:901-509-3409
Mailing Address - Fax:901-509-3409
Practice Address - Street 1:4466 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7180
Practice Address - Country:US
Practice Address - Phone:901-509-3409
Practice Address - Fax:901-509-3409
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker