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General NPI Number Information
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NPI Number | 1568456853
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Entity Type | Individual
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Provider Name | BRANDI D WILSON MD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 840 37TH PL
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City | VERO BEACH
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State | FL
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Zip | 32960-6502
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Country | US
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Telephone | 772-567-6412
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Fax |
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Provider Business Mailing Address
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Address Line | 5675 ROE BLVD STE 100
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City | ROELAND PARK
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State | KS
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Zip | 66205-2538
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Country | US
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Telephone | 913-432-2080
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Fax | 913-432-5183
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0430206
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME160442
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License Number State | FL
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