Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 011256 | NY |
Y | 111NR0400X | Rehabilitation Chiropractor | 3851 | NJ |
NPI | 1033232830 |
---|---|
Provider Name | Dr. Pamela Eileen Wilson |
First Address | Red Bank, NJ 07701-1734 |
Second Address | Red Bank, NJ 07701-1734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 16/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P413708 | OXFORD INS ID# (01) | NJ |
U24383 | (02) | NJ |