Provider Demographics
NPI:1316489552
Name:WILSON, LUZVELINDA M
Entity type:Individual
Prefix:MRS
First Name:LUZVELINDA
Middle Name:M
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 1:91-992 PAPAPUHI PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4722
Mailing Address - Country:US
Mailing Address - Phone:808-393-9301
Mailing Address - Fax:888-958-4492
Practice Address - Street 1:91-992 PAPAPUHI PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4722
Practice Address - Country:US
Practice Address - Phone:808-393-9301
Practice Address - Fax:888-958-4492
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-160072376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1-160072OtherCCFFH LICENSE NUMBER