MEDICARE: TERESA ANN WILSON CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	381413	NY

General Provider Information

NPI Number	:	1457492027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN WILSON CPNP

Provider Business Mailing Address
First Line	:	3961 HILLMAN AVE
Second Line	:	MONTEFIORE SCHOOL HEALTH CLINIC
City	:	BRONX
State	:	NY
Zip	:	10463-3001
Country	:	US
Telephone Number	:	718-796-3440
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 HILLMAN AVE
Second Line	:	MONTEFIORE SCHOOL HEALTH CLINIC
City	:	BRONX
State	:	NY
Zip	:	10463-3001
Country	:	US
Telephone Number	:	718-796-3440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/28/2012

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