Provider Demographics
NPI:1235612060
Name:WILSON, ANITA OSEI (RN-BSN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:OSEI
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:OSEI
Other - Last Name:OWUSU-ANSAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 STUYVESANT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6029
Mailing Address - Country:US
Mailing Address - Phone:908-258-8096
Mailing Address - Fax:
Practice Address - Street 1:1021 STUYVESANT AVE STE 2
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6029
Practice Address - Country:US
Practice Address - Phone:908-258-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16626800163WM0705X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHP0281400Medicaid
NJ$$$$$$$$$Medicaid