Healthcare Provider Details

I. General information

NPI: 1295260941
Provider Name (Legal Business Name): EVA WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HULL STREET RD
MIDLOTHIAN VA
23112-2002
US

IV. Provider business mailing address

13800 HULL STREET RD
MIDLOTHIAN VA
23112-2002
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-9498
  • Fax:
Mailing address:
  • Phone: 804-730-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: