Healthcare Provider Details

I. General information

NPI: 1457631400
Provider Name (Legal Business Name): NADIA AZIZ WILSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NADIA MICHELLE AZIZ

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

411 EAST 75TH ST APT 2C
NEW YORK NY
10021-3178
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-6911
  • Fax:
Mailing address:
  • Phone: 917-710-3624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336428-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: