Healthcare Provider Details

I. General information

NPI: 1205655602
Provider Name (Legal Business Name): HIGHLAND ADVANCED PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HARDING BLVD STE 103E
ROSEVILLE CA
95678-2471
US

IV. Provider business mailing address

572 FIFTEEN MILE DR
ROSEVILLE CA
95678-5921
US

V. Phone/Fax

Practice location:
  • Phone: 773-308-3139
  • Fax:
Mailing address:
  • Phone: 773-308-3139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA WILLIAM LAIRD-WILSON
Title or Position: CLINICIAN, CEO
Credential: FNP-BC
Phone: 773-308-3139