Provider Demographics
NPI:1215694054
Name:WILSON, ELISHA NICOLE
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12604 KING ARTHUR CT
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8911
Mailing Address - Country:US
Mailing Address - Phone:240-245-7487
Mailing Address - Fax:
Practice Address - Street 1:12604 KING ARTHUR CT
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-8911
Practice Address - Country:US
Practice Address - Phone:240-245-7487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula