Healthcare Provider Details

I. General information

NPI: 1750362687
Provider Name (Legal Business Name): SHEILA S. WILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CARPENTER RD
FORT MYER VA
22211-1009
US

IV. Provider business mailing address

3483 LYON PARK CT
WOODBRIDGE VA
22192-1022
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3216
  • Fax: 703-696-0103
Mailing address:
  • Phone: 703-491-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number0001193727
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: