Provider Demographics
NPI:1083269492
Name:WILSON, SALLY SOBON (DNP, MSN, AGNP-C, RN)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:SOBON
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP, MSN, AGNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-0366
Mailing Address - Country:US
Mailing Address - Phone:609-457-0900
Mailing Address - Fax:
Practice Address - Street 1:213 WEST AVE
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:NJ
Practice Address - Zip Code:08226-4131
Practice Address - Country:US
Practice Address - Phone:609-399-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00928700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care