Healthcare Provider Details

I. General information

NPI: 1174471007
Provider Name (Legal Business Name): EMILY DAVIS WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 W BROADWAY
LINCOLN ME
04457-4000
US

IV. Provider business mailing address

38 INDEPENDENCE LN
EAST MILLINOCKET ME
04430-1022
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-6700
  • Fax:
Mailing address:
  • Phone: 207-794-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP261151
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: