Individual
BERNISE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12900 PARK PLAZA DR, CERRITOS, CA 90703-9329
(866) 646-3553
Mailing address
PO BOX 15921, LONG BEACH, CA 90815-0921
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP95003938
CA
Other
Enumeration date
08/30/2007
Last updated
05/08/2018
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