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Elizabeth Oludayo Wilson-Durham

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

1237 Harding Pl, Ste 3100, Charlotte, NC 28204

PECOS Enrollment

This provider is enrolled in PECOS as ELIZABETH WILSON-DURHAM.

Based on the most recent information from CMS, provider Elizabeth Oludayo Wilson-Durham is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:59 PM.

Profile Details

Provider ID
1003932971
Provider Type
Individual
Full Name
Wilson-Durham, Elizabeth Oludayo
Credential
FNP

Gender
Female
Sole Proprietor
No
Enumeration Date
3/22/2007
Last Updated
7/16/2024

Contact Information

Practice Location

1237 Harding Pl, Ste 3100, Charlotte, NC 28204

(704) 373-0212

Unlisted Fax

Mailing Location

PO Box 19305, Charlotte, NC 28219-9305

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5008512 North Carolina
Code 363L00000X	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 5008512 North Carolina

Elizabeth Oludayo Wilson-Durham

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Short, Susannah Kelly

Garcia, Camille

Kinzer, Eva Marie

Heslop, Jaclyn Leigh

Blair-Rutherford, Kristie Lynn

Calandra, Jennifer Ann

Leasure, Stephanie Maho Benton

Fitzgerald, Ciera Caylin

Lewis, Shannon Marie

Finnigan, Mary Kathleen