Provider Demographics
NPI:1104060813
Name:WILSON, ELENA CHRISTINE (LPN)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:CHRISTINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 POTOMAC VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2757
Mailing Address - Country:US
Mailing Address - Phone:301-762-0700
Mailing Address - Fax:
Practice Address - Street 1:1235 POTOMAC VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2757
Practice Address - Country:US
Practice Address - Phone:301-762-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP28225164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse