Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | SP010096 | PA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9397265 | FL |
NPI | 1013154004 |
---|---|
Provider Name | Laura Denise Shapiro Wilson |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Cape Coral, FL 33909-1756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022651500 | (05) | FL |