Provider Demographics
NPI:1992921027
Name:WILSON, SUE FESMIRE (RNC-OGNP)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:FESMIRE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RNC-OGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6082 SMITHWOOD RD.
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:NC
Mailing Address - Zip Code:27283-9206
Mailing Address - Country:US
Mailing Address - Phone:336-685-9977
Mailing Address - Fax:
Practice Address - Street 1:2501 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-9087
Practice Address - Country:US
Practice Address - Phone:919-968-2022
Practice Address - Fax:919-968-2013
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC088507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist