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General NPI Number Information
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NPI Number | 1124893151
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Entity Type | Individual
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Provider Name | DOMONIQUE S WILSON PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/20/2023
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 3000 PARK PLACE DR STE 108
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City | WASHINGTON
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State | PA
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Zip | 15301-2068
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Country | US
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Telephone | 724-374-3468
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Fax | 724-258-8914
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Provider Business Mailing Address
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Address Line | 230 N CRAIG ST STE B
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City | PITTSBURGH
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State | PA
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Zip | 15213-1569
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Country | US
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Telephone | 610-892-3800
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRNCNP0035421
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP029678
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License Number State | PA
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