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General NPI Number Information
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NPI Number | 1437982824
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Entity Type | Individual
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Provider Name | STEPHEN R WILSON
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Gender | Male
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Dates
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Enumeration Date | 08/22/2024
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 859-361-1834
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Fax | 808-433-7744
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Provider Business Mailing Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 859-361-1834
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 268575
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28168656A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 113438
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License Number State | HI
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