Individual
CHANELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
249 MILLINGTON RD, CORTLANDT MANOR, NY 10567
(610) 442-0979
Mailing address
249 MILLINGTON RD, CORTLANDT MANOR, NY 10567-1637
(610) 442-0979
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
341582
NY
Other
Enumeration date
10/26/2017
Last updated
10/26/2017
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