Individual
KIM MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
3400 SPRUCE ST, 4 DULLES BUILDING, PHILADELPHIA, PA 19104-4206
(215) 615-4949
Mailing address
3400 SPRUCE ST, 4 DULLES BLDG, PHILADELPHIA, PA 19104-4206
(215) 615-4949
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
TP004563U
PA
Other
Enumeration date
05/10/2007
Last updated
11/18/2013
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