Active NPI
Stella Elizabeth Wilson, M.T.
- Medical Technologist
- Dulce, NM
National Provider Identifier
1891085262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Technologist
- License
- TN 26432
- Practice address
- 500 Stone Lake Road
Dulce, NM 87528 - Phone
- (575) 759-7309
- Fax
- (575) 759-7294
- NPI assigned
- Apr 19, 2011
- Last updated
- Jun 13, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | TN 26432 | FL | Primary |
Addresses
Primary practice location
500 Stone Lake Road
Dulce, NM 87528
Mailing address
500 Stone Lake Road
Dulce, NM 87528
Phone (575) 759-7309
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)
- Not enrolled
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TN 26432 | FL | MD | Medical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1891085262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 STONE LAKE ROAD",
"city": "DULCE",
"state": "NM",
"postal_code": "87528",
"telephone_number": "575-759-7309",
"fax_number": "575-759-7294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 STONE LAKE ROAD",
"city": "DULCE",
"state": "NM",
"postal_code": "87528",
"telephone_number": "575-759-7309",
"fax_number": "575-759-7294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "STELLA",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "M.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-04-19",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "246QM0706X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Medical Technologist",
"state": "FL",
"license": "TN 26432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.