Individual
CHRISTINE M WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2038 RUSSELL ST, BELLMORE, NY 11710-3224
(516) 238-5539
Mailing address
2500 PUTNAM DRIVE, EAST MEADOW, NY 11710
(516) 238-5539
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
543328-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
NY
Enumeration date
07/10/2017
Last updated
07/10/2017
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