Individual
MS. MARY DEBORAH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
11022 NICHOLAS LN, UNIT 2 SUITE 1, BERLIN, MD 21811-3353
(410) 641-5190
(410) 641-5463
Mailing address
11022 NICHOLAS LN, UNIT 2 SUITE 1, BERLIN, MD 21811-3352
(410) 641-5190
(410) 641-5463
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R056757
MD
363LG0600X
Gerontology Nurse Practitioner
R056757
MD
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R056757
MD
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
R056757
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
259147-000
MAGELLAN BEHAVIORAL HEALTH
MD
01
—
346646
MANAGED HEALTH NET/TRICARE
MD
01
—
499188
BEACON HEALTH OPTIONS
MD
01
—
517251
OPTUM
MD
05
—
609550001
—
MD
05
—
609550002
—
MD
05
—
609550004
—
MD
01
—
7840093
AETNA
MD
01
—
R968
CAREFIRST OF MARYLAND
MD
Enumeration date
05/12/2007
Last updated
06/12/2020
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