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Individual
MR. BRIAN WILSON
Active
Individual
MR. BRIAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R224388
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R224388
REGISTERED NURSE STATE LICENSE
MD
Enumeration date
08/02/2017
Last updated
08/02/2017
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