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General NPI Number Information
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NPI Number | 1023519337
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Entity Type | Individual
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Provider Name | CHRISTINA GRACE WILSON AGNP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 240 E 38TH ST FL 19
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City | NEW YORK
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State | NY
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Zip | 10016-2708
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Country | US
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Telephone | 646-501-4834
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Fax |
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Provider Business Mailing Address
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Address Line | 124 LUDLOW ST APT 1D
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City | NEW YORK
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State | NY
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Zip | 10002-3253
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Country | US
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Telephone | 914-844-5229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 308575
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License Number State | NY
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