Provider Demographics
NPI:1093303489
Name:WILSON, SHERLY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHERLY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 HUNTINGDON PIKE STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8359
Mailing Address - Country:US
Mailing Address - Phone:215-324-5052
Mailing Address - Fax:
Practice Address - Street 1:927 HUNTINGDON PIKE STE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8359
Practice Address - Country:US
Practice Address - Phone:215-324-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty