Provider Demographics
NPI:1083047369
Name:WILSON, BRIANNA JEAN (DNP, ARNP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:JEAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:JEAN
Other - Last Name:BOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-2104
Mailing Address - Country:US
Mailing Address - Phone:360-630-5141
Mailing Address - Fax:866-302-7491
Practice Address - Street 1:708 E MORRIS ST
Practice Address - Street 2:STE B
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-9825
Practice Address - Country:US
Practice Address - Phone:360-630-5141
Practice Address - Fax:877-850-2373
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60404988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1083047369Medicaid
WA8922646Medicare Oscar/Certification