| Doctor Name: | MRS. THERESA RUSS WILSON |
| NPI Number: | 1326104506 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 098763 |
| Business Practice Address: | 201 Government Cir Greenville, NC - 278348198 |
| Business Phone Number: | 2529022349 |
| Business Fax Number: | |
| Mailing Address: | 3105 Tucker Dr, GREENVILLE |
| State: | NC |
| Postal Code: | 278586017 |
| Phone Number: | 2523532427 |
| Fax Number: | |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 098763 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |