Provider Demographics
NPI:1346512241
Name:WILSON-CYRUS, JEMMA V
Entity Type:Individual
Prefix:MRS
First Name:JEMMA
Middle Name:V
Last Name:WILSON-CYRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 MAPLE ST
Mailing Address - Street 2:APT. D7
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4173
Mailing Address - Country:US
Mailing Address - Phone:718-940-3969
Mailing Address - Fax:
Practice Address - Street 1:395 MAPLE ST
Practice Address - Street 2:APT. D7
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4173
Practice Address - Country:US
Practice Address - Phone:718-940-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY634727-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse