Healthcare Provider Details

I. General information

NPI: 1790782019
Provider Name (Legal Business Name): NATALIE LYNN WILSON MSN, APRN, BC, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S KINGS DR
CHARLOTTE NC
28207-2134
US

IV. Provider business mailing address

PO BOX 32861
CHARLOTTE NC
28232-2861
US

V. Phone/Fax

Practice location:
  • Phone: 704-446-1242
  • Fax:
Mailing address:
  • Phone: 704-446-1242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200852
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: