| Doctor Name: | SHELLEY WILSON |
| NPI Number: | 1982080461 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | L1-361510 |
| Business Practice Address: | 400 Walnut St Ste A Pocomoke City, MD - 218511501 |
| Business Phone Number: | 4109572005 |
| Business Fax Number: | 4109572417 |
| Mailing Address: | Po Box 249, SNOW HILL |
| State: | MD |
| Postal Code: | 218630249 |
| Phone Number: | 4106321100 |
| Fax Number: | 4106322476 |
| NPI Enumeration Date: | 08/06/2015 |
| NPI Last Update Date: | 08/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | L1-361510 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |