Laura Renae Wilson, MSN, APRN-BC
Nurse Practitioner, Primary Care in Stone Mountain, GA. Individual provider (NPI-1).
NPI number1104032218
StatusActive
Last updated in NPPESMar 6, 2019
Details
- NPI
- 1104032218
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Laura Renae Wilson
- Credential
- MSN, APRN-BC
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- May 15, 2007
- Last updated
- Mar 6, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | RN247115 | GA | Yes |
| 363LF0000X | Nurse Practitioner, Family | 004365 | CT | |
| 363LF0000X | Nurse Practitioner, Family | 701633 | TX |
Other names
- Laura Renae Phelps (Former Name)
Practice location
5405 Memorial Dr Ste DStone Mountain, GA 30083-3236
Phone 404-296-3800 · Fax 404-297-8753
Mailing address
5405 Memorial Dr Ste DStone Mountain, GA 30083-3236
Phone 404-296-3800 · Fax 404-297-8753
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