# MS. MARY DEBORAH WILSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1306051313
- **Gender:** F
- **Credential:** PMHNP-BC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R056757 | MD | — |
| 363LG0600X | Gerontology Nurse Practitioner | R056757 | MD | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | R056757 | MD | Yes |
| 364SP0809X | Adult Psychiatric/Mental Health Clinical Nurse Specialist | R056757 | MD | — |

## Other

- **Enumeration date:** 05/12/2007
- **Last updated:** 06/12/2020