Provider Demographics
NPI:1588087100
Name:WILSON, JANELLA (CNA/MEDICINE TECH)
Entity type:Individual
Prefix:
First Name:JANELLA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNA/MEDICINE TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5235
Mailing Address - Country:US
Mailing Address - Phone:919-884-5141
Mailing Address - Fax:
Practice Address - Street 1:1202 KENDALL DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5235
Practice Address - Country:US
Practice Address - Phone:919-884-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC373504372500000X, 372600000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker