Healthcare Provider Details

I. General information

NPI: 1831572734
Provider Name (Legal Business Name): GINA MARIE WILSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

IV. Provider business mailing address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2325
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4000
  • Fax: 904-249-3371
Mailing address:
  • Phone: 919-956-4000
  • Fax: 919-667-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number244366
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: