Provider Demographics
NPI:1427786045
Name:WILSON, LAURA STANTON (DVM, DACVD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:STANTON
Last Name:WILSON
Suffix:
Gender:F
Credentials:DVM, DACVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2843
Mailing Address - Country:US
Mailing Address - Phone:949-500-7911
Mailing Address - Fax:
Practice Address - Street 1:2001 CAMPBELL STATION PKWY STE C1
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7597
Practice Address - Country:US
Practice Address - Phone:615-438-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7569207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology