Individual
MRS. CELINA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
17 BANK AVE, SMITHTOWN, NY 11787-2703
(631) 584-5985
Mailing address
24 STONY RD, STONY BROOK, NY 11790-1516
(631) 338-4340
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
421695-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
421695-1
REGISTERD NURSE LICENSE
NY
Enumeration date
07/04/2020
Last updated
07/04/2020
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