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General NPI Number Information
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NPI Number | 1548580541
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Entity Type | Individual
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Provider Name | STACY-ANN NICOLE WILSON RT
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Gender | Female
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 09/26/2011
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Provider Practice Location Address
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Address Line | 796 NANNYBERRY LN
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City | CONCORD
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State | NC
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Zip | 28025-9039
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Country | US
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Telephone | 252-413-9604
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Fax | 704-469-6100
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Provider Business Mailing Address
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Address Line | 796 NANNYBERRY LN
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City | CONCORD
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State | NC
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Zip | 28025-9039
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Country | US
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Telephone | 252-413-9604
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Fax | 704-469-6100
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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 | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | A-5962
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License Number State | NC
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