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General NPI Number Information
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NPI Number | 1801937859
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Entity Type | Individual
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Provider Name | ALICE R WILSON-EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 02/11/2007
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 801 OSTRUM ST
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City | BETHLEHEM
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State | PA
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Zip | 18015-1000
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Country | US
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Telephone | 215-829-3264
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Fax |
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Provider Business Mailing Address
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Address Line | 801 OSTRUM ST
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City | BETHLEHEM
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State | PA
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Zip | 18015-1000
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Country | US
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Telephone |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | C0003416
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA053836
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License Number State | PA
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