Healthcare Provider Details

I. General information

NPI: 1518484633
Provider Name (Legal Business Name): ALECIA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 W STATE ST STE 302
DOYLESTOWN PA
18901-2567
US

IV. Provider business mailing address

PO BOX 829641
PHILADELPHIA PA
19182-9641
US

V. Phone/Fax

Practice location:
  • Phone: 152-306-9822
  • Fax: 215-230-3983
Mailing address:
  • Phone: 267-370-5285
  • Fax: 215-230-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN607015
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018525
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: