Healthcare Provider Details

I. General information

NPI: 1568943116
Provider Name (Legal Business Name): DANA WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2018
Last Update Date: 10/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ESSEX ST
NEW YORK NY
10002-2301
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-1120
  • Fax: 212-477-8957
Mailing address:
  • Phone: 212-545-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number595297
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF343714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: