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NPI Code Detail

MEDICARE: MICHELLE WILSON APN-C

MEDICARE: MICHELLE WILSON APN-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerSP027848PA

General Provider Information

NPI Number : 1740064823
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE WILSON APN-C
Provider Business Mailing Address
First Line : 3803 W CHESTER PIKE STE 160
Second Line :
City : NEWTOWN SQUARE
State : PA
Zip : 19073-2336
Country : US
Telephone Number : 484-337-1632
Fax Number :
Provider Business Practice Location Address
First Line : 107 TOWN CENTER RD
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-2330
Country : US
Telephone Number : 484-750-5212
Fax Number : 484-750-5212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 07/25/2024

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Directions to “ MICHELLE WILSON APN-C” Practice Location

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