Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP9536 / RN361797 | CA |
NPI | 1003857277 |
---|---|
Provider Name | Marie Elizabeth Wilson |
First Address | Arcadia, CA 91066-0879 |
Second Address | Oxnard, CA 93030-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 07/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P23935 | (02) | CA |
RN361797 | (05) | CA |