Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 26NJ00928700 | NJ |
NPI | 1083269492 |
---|---|
Provider Name | Dr. Sally Sobon Wilson |
First Address | Ocean City, NJ 08226-0366 |
Second Address | Ocean City, NJ 08226-4131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2019 |
Last Update Date | 03/08/2019 |