Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP015554 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP015554 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP015554 | PA |
NPI | 1073988374 |
---|---|
Provider Name | Cristhi Wilson-Brown |
First Address | Philadelphia, PA 19143-3101 |
Second Address | Philadelphia, PA 19123-1428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2015 |
Last Update Date | 11/12/2015 |