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General NPI Number Information
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NPI Number | 1013154004
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Entity Type | Individual
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Provider Name | LAURA DENISE SHAPIRO WILSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 1682 NE PINE ISLAND RD
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City | CAPE CORAL
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State | FL
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Zip | 33909-1756
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Country | US
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Telephone | 239-424-1655
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Fax | 239-424-1649
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-424-1655
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Fax | 239-424-1649
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN562789
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP010096
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9397265
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License Number State | FL
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