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Individual
LISA MARIE WILSON
Active
Individual
LISA MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
605899-1
NY
363LF0000X
Family Nurse Practitioner
345130
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134415755
—
NY
Enumeration date
06/22/2011
Last updated
02/06/2023
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