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General NPI Number Information
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NPI Number | 1932140944
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Entity Type | Individual
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Provider Name | MONIQUE S. WILSON APN
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 3 COOPER PLZ SUITE 411
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City | CAMDEN
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State | NJ
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Zip | 08103-1438
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Country | US
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Telephone | 856-968-3577
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Fax | 856-968-8457
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Provider Business Mailing Address
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Address Line | 1 FEDERAL STREET SUITE SW200
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City | CAMDEN
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State | NJ
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Zip | 08103-1155
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Country | US
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Telephone | 856-356-4935
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NN093565
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License Number State | NJ
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