Healthcare Provider Details

I. General information

NPI: 1720908056
Provider Name (Legal Business Name): ABIGAIL TESS WILSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 MORRIS AVE
UNION NJ
07083-4851
US

IV. Provider business mailing address

2840 MORRIS AVE
UNION NJ
07083-4851
US

V. Phone/Fax

Practice location:
  • Phone: 888-244-5373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ15642600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR27601300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: