Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 308575 | NY |
NPI | 1023519337 |
---|---|
Provider Name | Ms. Christina Grace Wilson |
First Address | New York, NY 10002-3253 |
Second Address | New York, NY 10016-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 22/02/2018 |