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General NPI Number Information
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NPI Number | 1104828607
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Entity Type | Individual
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Provider Name | PAULA JEAN WILSON APRN
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Gender | Female
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIT 2709 BOX 6
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City | APO
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State | NY
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Zip | 34021-2709
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Country | US
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Telephone | 505-266-4925
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Fax | 505-266-9941
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Provider Business Mailing Address
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Address Line | RR 1 BOX 51G
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City | JASONVILLE
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State | IN
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Zip | 47438-9801
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Country | US
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Telephone | 11-505-2664
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Fax | 505-266-9941
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN1002465
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License Number State | DC
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