Provider Demographics
NPI:1699477844
Name:WILSON, LAURINA (APRN)
Entity type:Individual
Prefix:
First Name:LAURINA
Middle Name:
Last Name:WILSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:LAURINA
Other - Middle Name:
Other - Last Name:YEBOAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1585 NEIL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1216
Mailing Address - Country:US
Mailing Address - Phone:614-292-4041
Mailing Address - Fax:
Practice Address - Street 1:1585 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1216
Practice Address - Country:US
Practice Address - Phone:614-292-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0036101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner