Provider Demographics
NPI:1134499676
Name:WILSON, KAREN ANN-MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:KAREN
Middle Name:ANN-MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 SAW MILL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1509
Mailing Address - Country:US
Mailing Address - Phone:914-336-7103
Mailing Address - Fax:914-328-3166
Practice Address - Street 1:265 SAW MILL RIVER RD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1509
Practice Address - Country:US
Practice Address - Phone:914-495-4500
Practice Address - Fax:914-328-3166
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597177-1163W00000X
NY404223363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse