Individual
NICOLE CELESTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7600 CENTRAL AVE, PHILADELPHIA, PA 19111-2442
(215) 728-2112
Mailing address
1613 WOODBROOK LN, PHILADELPHIA, PA 19150-1021
(267) 974-2372
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN309077L
PA
Other
Enumeration date
10/20/2009
Last updated
10/20/2009
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