1811676380 NPI number — MRS. CORA LYN WILSON DNP, APRN, FNP-BC

Table of content: MRS. CORA LYN WILSON DNP, APRN, FNP-BC (NPI 1811676380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811676380 NPI number — MRS. CORA LYN WILSON DNP, APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
CORA
Provider Middle Name:
LYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GLASER
Provider Other First Name:
CORA
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811676380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 1ST ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55905-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-284-2511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 1ST ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55905-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-284-2511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  10414 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 15059-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)