Wilson, Carlene A.
Wilson, Carlene A. is an individual health care provider with primary practice located at 6038 W Nordling Loop , Crystal River FL 34429. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Wilson, Carlene A. can be contacted via phone (352) 563-5070.Contact Information
Primary practice address
6038 W Nordling Loop
Crystal River FL 34429
Phone: (352) 563-5070
Fax: (352) 795-4322
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | ME93743 | Florida |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ME93743 | Florida |
Profile Details
| NPI number | 1407850365 |
|---|---|
| LBN Legal business name | Wilson, Carlene A. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2005 |
| Last updated | Jun 9th, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407850365 | NPPES |
| South Carolina | MEDICAID | 271841 | |
| South Carolina | MEDICAID | 273971200 | |
| South Carolina | Other | 5705127861001 | |
| South Carolina | MEDICAID | GP0237 | |
| South Carolina | MEDICAID | 428955383A | |
| South Carolina | Other | 30031 |
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