Basic Information
| Provider Information | |||||||||
| NPI: | 1144778101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | MONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 E 104 TH ST | ||||||||
| Address2: | MAILSTOP 400N | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165999499 | ||||||||
| FaxNumber: | 8169329670 | ||||||||
| Practice Location | |||||||||
| Address1: | 12330 METCALF AVE STE 420 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662131307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134919100 | ||||||||
| FaxNumber: | 9134919135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2016 | ||||||||
| LastUpdateDate: | 11/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 2016032508 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.