Healthcare Provider Details

I. General information

NPI: 1427337559
Provider Name (Legal Business Name): ROXANNE MILES WILSON MN,FNP/GNP,DSD,PHN,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 09/22/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23055 MARIANO ST
WOODLAND HILLS CA
91367-6135
US

IV. Provider business mailing address

23055 MARIANO STRE ROXANNE WILSON CONSULTING
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 818-522-2612
  • Fax: 818-912-6449
Mailing address:
  • Phone: 818-522-2612
  • Fax: 818-912-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN362861
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN362861
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number6708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: