Healthcare Provider Details

I. General information

NPI: 1861732612
Provider Name (Legal Business Name): CONSTANCE MARIE WILSON MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

IV. Provider business mailing address

305 CARPENTER RD
FORT COLLINS CO
80525-4248
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-3500
  • Fax: 970-292-0898
Mailing address:
  • Phone: 970-663-3500
  • Fax: 970-292-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60318539
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992803-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: