Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | RN500867 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP11538 | CA |
NPI | 1760598130 |
---|---|
Provider Name | Errol Wilson |
First Address | Indio, CA 92201-5577 |
Second Address | Indio, CA 92201-5577 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 12/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MW1215640 | DEA (01) | WA |