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General NPI Number Information
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NPI Number | 1780380329
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Entity Type | Individual
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Provider Name | JUDITH A WILSON
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Gender | Female
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1000 S ELMORA AVE
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City | ELIZABETH
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State | NJ
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Zip | 07202-3100
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Country | US
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Telephone | 908-737-5703
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Fax | 908-325-0075
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Provider Business Mailing Address
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Address Line | PO BOX 740021
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City | ATLANTA
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State | GA
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Zip | 30374-0021
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Country | US
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Telephone | 312-733-9730
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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 | 26NJ01437000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ01437000
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ01437000
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License Number State | NJ
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