Provider Demographics
NPI:1548284870
Name:WILSON, ELLA D (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8056
Mailing Address - Country:US
Mailing Address - Phone:985-781-7337
Mailing Address - Fax:985-781-7339
Practice Address - Street 1:1430 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8056
Practice Address - Country:US
Practice Address - Phone:985-781-7337
Practice Address - Fax:985-781-7339
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP04842OtherLICENSE NUMBER