Stella Elizabeth Wilson, M.T.
Individual provider Active NPI Medical Technologist · Dulce, NM
NPI 1891085262 · NPPES record last updated Jun 13, 2012
Key facts
- NPI
- 1891085262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Technologist 246QM0706X
- License
- TN 26432 (FL)
- Practice address
- 500 Stone Lake Road
Dulce, NM 87528 - Phone
- (575) 759-7309
- Fax
- (575) 759-7294
- NPI assigned
- Apr 19, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TN 26432 | FL | MD | Medical Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | TN 26432 | FL | Yes |
Addresses
Primary practice location
500 Stone Lake Road
Dulce, NM 87528
Mailing address
500 Stone Lake Road
Dulce, NM 87528
Phone (575) 759-7309
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| K3526 | Medicaid | NM |
Other providers in Dulce, NM
- Inna Voinich
- Nancy Jane Watts
- Mitchell R. Wilkinson
- Kristine S Williams
- E Joan Wilson
- David Zuflacht
All providers in Dulce, NM · Medical Technologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.