Individual
KAYANN WILSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-7738
Mailing address
19 GETTYSBURG RD, SOUTHBURY, CT 06488-3018
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
303712
NY
Other
Enumeration date
01/24/2006
Last updated
07/08/2007
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