Individual
JACQUELINE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
49 N OCEAN AVE, RONKONKOMA, NY 11779-5015
(631) 487-8997
Mailing address
49 N OCEAN AVE, RONKONKOMA, NY 11779-5015
(631) 487-8997
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
432663
NY
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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