Provider Demographics
NPI:1699429944
Name:WILSON, SHIRLEY MAY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MAY
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 1:23 SENIOR CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9581
Mailing Address - Country:US
Mailing Address - Phone:304-765-4090
Mailing Address - Fax:
Practice Address - Street 1:19 FREEDOM TRL
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:WV
Practice Address - Zip Code:26621-8079
Practice Address - Country:US
Practice Address - Phone:304-701-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant