Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 3016183 | KY |
NPI | 1043608052 |
---|---|
Provider Name | Karen Louise Wilsman |
First Address | Miami Gardens, FL 33169-5710 |
Second Address | Louisville, KY 40216-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2014 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1043608052 | NPI (01) | |
469208 | (05) | AZ |