Healthcare Provider Details

I. General information

NPI: 1881185270
Provider Name (Legal Business Name): CATHERINE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 KINGSTOWN RD
WAKEFIELD RI
02879-3626
US

IV. Provider business mailing address

64 HIGGINS DR
KINGSTON RI
02881-1506
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-0283
  • Fax: 401-789-0314
Mailing address:
  • Phone: 401-789-0283
  • Fax: 401-789-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN04888
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR193677
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR193677
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: