Individual
DIANE GAIL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 663-8369
(516) 663-3698
Mailing address
PO BOX 27686, NEW YORK, NY 10087-7686
(865) 766-8800
(865) 450-9374
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
F381239
NY
Other
Enumeration date
11/07/2011
Last updated
11/07/2011
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