Healthcare Provider Details

I. General information

NPI: 1144231101
Provider Name (Legal Business Name): DAISY WILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY HEALTH CLINIC CAMP CASEY
APO AP
96224-0312
KR

IV. Provider business mailing address

C CO 302D BSB ATTN : TMC UNIT # 15609
APO AP
96224-5609
KR

V. Phone/Fax

Practice location:
  • Phone: 01182318696796
  • Fax: 01182318696727
Mailing address:
  • Phone: 01182318696796
  • Fax: 01182318696727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number184852
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: