Provider Demographics
NPI:1982949160
Name:WILSON, DARLA
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:
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 1:104 BIG BEND RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:NV
Mailing Address - Zip Code:89442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 BIG BEND RANCH ROAD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:NV
Practice Address - Zip Code:89442
Practice Address - Country:US
Practice Address - Phone:775-352-6845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN62426163WA0400X, 163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)