Provider Demographics
NPI:1144458134
Name:WILSON, FELISA LAVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:FELISA
Middle Name:LAVONNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12226 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1865
Mailing Address - Country:US
Mailing Address - Phone:410-570-5519
Mailing Address - Fax:
Practice Address - Street 1:983075 NEBRASKA MEDICAL CTR
Practice Address - Street 2:FAMILY PRACTICE RESIDENCY DEPT
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-3075
Practice Address - Country:US
Practice Address - Phone:410-570-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine