Healthcare Provider Details

I. General information

NPI: 1932547775
Provider Name (Legal Business Name): EMILY ANN WILSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING STREET, HOSPITALISTS DEPT AUBURN COMMUNITY HOSPITAL
AUBURN NY
13021-1983
US

IV. Provider business mailing address

17 LANSING STREET ATTN: CHRIS MILLER
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-7438
  • Fax: 315-255-7099
Mailing address:
  • Phone: 315-567-0455
  • Fax: 315-253-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF337980-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: