Healthcare Provider Details

I. General information

NPI: 1285060145
Provider Name (Legal Business Name): KAREN AMANDA WILSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 59TH ST SUITE 10 A
NEW YORK NY
10022-1304
US

IV. Provider business mailing address

110 E 59TH ST SUITE 10 A
NEW YORK NY
10022-1304
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-4500
  • Fax:
Mailing address:
  • Phone: 212-434-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number620736
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number338320
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: