Basic Information
| Provider Information | |||||||||
| NPI: | 1821406026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | ROSANNE | ||||||||
| MiddleName: | B. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 AIRPORT BLVD STE A101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516338880 | ||||||||
| FaxNumber: | 2513786222 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 AIRPORT BLVD STE A101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086767 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516338880 | ||||||||
| FaxNumber: | 2513786209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 01/18/2019 | ||||||||
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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 | 363LF0000X | 1-115744 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.