Physician Compare National (NPI:1578939682)

HEALTHCARE PROVIDER: JAMEELAH WILSON FNP-C

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1578939682
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8820305063
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150921000509
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILSON
	Individual professional last name
Provider First Name	JAMEELAH
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1237 S VAL VISTA DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 117 118
	Group Practice or individual's line 2 address
City	MESA
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	852046401
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y