Healthcare Provider Details

I. General information

NPI: 1316135395
Provider Name (Legal Business Name): DEBORA BROOKS-WILSON C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 E LINCOLN HWY
COATESVILLE PA
19320-3539
US

IV. Provider business mailing address

3039 FOULK RD 2 NORTH
GARNET VALLEY PA
19060-1701
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-5899
  • Fax: 610-384-8385
Mailing address:
  • Phone: 610-361-0070
  • Fax: 610-361-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009508
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: