Basic Information
| Provider Information | |||||||||
| NPI: | 1881672194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 575 SNEDIKER AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112076503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184980229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 451 CLARKSON AVE | ||||||||
| Address2: | KINGS COUNTY HOSPITAL CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182453131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F332905 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.