Provider Demographics
NPI:1477386423
Name:WILSON, SHELLEE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:SHELLEE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WATERFRONT ST STE 420
Mailing Address - Street 2:#2041
Mailing Address - City:NATIONAL HARBOR
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1122
Mailing Address - Country:US
Mailing Address - Phone:202-627-0449
Mailing Address - Fax:
Practice Address - Street 1:120 WATERFRONT ST STE 420
Practice Address - Street 2:#2041
Practice Address - City:NATIONAL HARBOR
Practice Address - State:MD
Practice Address - Zip Code:20745-1122
Practice Address - Country:US
Practice Address - Phone:202-627-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1044539163WL0100X
MI4704283675163WL0100X
MDR227269163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant