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General NPI Number Information
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NPI Number | 1699430678
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Entity Type | Individual
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Provider Name | ABIGAIL LEIGH WILSON
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Gender | Female
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ
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City | LOS ANGELES
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State | CA
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Zip | 90095-8358
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Country | US
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Telephone | 310-825-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-301-8771
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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 | RN651156
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95001723
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License Number State | CA
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