Individual
MRS. ALTHEA NERESSA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
506 6TH ST, BROOKLYN, NY 11215-3609
(718) 780-7700
Mailing address
2160 HOLLAND AVE APT E8, BRONX, NY 10462-1730
(718) 794-9340
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
009767
NY
Other
Enumeration date
07/05/2006
Last updated
07/08/2007
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