Healthcare Provider Details

I. General information

NPI: 1407296221
Provider Name (Legal Business Name): NATALIE ELENA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GOLISANO CHILDREN'S HOSPITAL 601 ELMWOOD AVE
ROCHESTER NY
14620
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 667 DIVISION OF PEDIATRIC CRITICAL CARE
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-8138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number312759
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number312759
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD216071
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: