Individual
MS. THERESA CECELIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
210 W 139TH ST, C/O EDWARD NICHOLS MD, NEW YORK, NY 10030-2109
(212) 234-2121
(212) 234-1759
Mailing address
210 W 139TH ST, C/O EDWARD NICHOLS MD, NEW YORK, NY 10030-2109
(212) 234-2121
(212) 234-1759
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
380137
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02146716
—
NY
Enumeration date
08/06/2009
Last updated
08/06/2009
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