Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 31437 | NC |
NPI | 1104803154 |
---|---|
Provider Name | Dr. Sheela Wilson |
First Address | Charlotte, NC 28211-4849 |
Second Address | Charlotte, NC 28262-3300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 15/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8915761 | (05) | NC |
C87383 | (02) | NC |