Provider Demographics
NPI:1386291326
Name:WILSON, TERESA ANN (CNA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 ARBORCREST DR.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-4010
Mailing Address - Country:US
Mailing Address - Phone:972-374-6225
Mailing Address - Fax:
Practice Address - Street 1:7104 ARBORCREST DR.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-4010
Practice Address - Country:US
Practice Address - Phone:972-374-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA80954583747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider