Healthcare Provider Details

I. General information

NPI: 1528065802
Provider Name (Legal Business Name): NILA L WILBUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 LEROY GEORGE DR STE X
CLYDE NC
28721-7430
US

IV. Provider business mailing address

934 UPPER CRABTREE RD
CLYDE NC
28721-7719
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-8346
  • Fax:
Mailing address:
  • Phone:
  • Fax: 828-452-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9401092
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: