Healthcare Provider Details

I. General information

NPI: 1447859004
Provider Name (Legal Business Name): ADIA NIARA WILSON-DAWSON WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST
BEVERLY MA
01915-2757
US

IV. Provider business mailing address

36 BELLVISTA RD APT 24
BRIGHTON MA
02135-7666
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3600
  • Fax:
Mailing address:
  • Phone: 347-628-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN2335257
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2335257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: