NPIMap

Individual provider Active NPI

Ethel A Wilson, RD, MS, LDN

  • Nutrition Education Nutritionist
  • Hagerstown, MD
National Provider Identifier
1467605089
Registry record updated Nov 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition Education NutritionistTaxonomy code 133NN1002X
License
D01601 Issued in MD
Practice address
11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700
Phone
(301) 714-4041
Fax
(301) 714-4351
NPI assigned
Oct 28, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education Nutritionist 133NN1002X D01601 MD Primary
Registered Dietitian 133V00000X D01601 MD

Addresses

Primary practice location

11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700

Mailing address

11110 Medical Campus Rd
Suite 108
Hagerstown, MD 21742-6700
Phone (301) 714-4041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

Practice roles

OrganizationSpecialtyStatusNew patients
Sodexo Operations LLC Dietitian, Registered Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1467605089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 108",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-714-4041",
            "fax_number": "301-714-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11110 MEDICAL CAMPUS RD",
            "address_2": "SUITE 108",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426700",
            "telephone_number": "301-714-4041",
            "fax_number": "301-714-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ETHEL",
        "middle_name": "A",
        "credential": "RD, MS, LDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-28",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "MD",
            "license": "D01601",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "D01601",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.