MEDICARE: LAURA WILSON FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	5019900	NC

General Provider Information

NPI Number	:	1548014301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WILSON FNP-C

Provider Business Mailing Address
First Line	:	2874 NC HWY 127 SOUTH
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9131
Country	:	US
Telephone Number	:	828-294-4100
Fax Number	:	828-294-4112

Provider Business Practice Location Address
First Line	:	2874 NC HWY 127 SOUTH
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-9131
Country	:	US
Telephone Number	:	828-294-4100
Fax Number	:	828-294-4112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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