Healthcare Provider Details

I. General information

NPI: 1811274327
Provider Name (Legal Business Name): LINDSAY BROOKE WILSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 PHYSICIANS BLVD SUITE 300
BAKERSFIELD CA
93301-1277
US

IV. Provider business mailing address

1430 TRUXTUN AVE SUITE 400
BAKERSFIELD CA
93301-5246
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-1455
  • Fax:
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-326-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number706754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: