Provider Demographics
NPI:1427210640
Name:WILSON, ALEJANDRA (PNP)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 6TH AVE
Mailing Address - Street 2:ROOM 138
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3507
Mailing Address - Country:US
Mailing Address - Phone:718-230-5707
Mailing Address - Fax:718-230-7546
Practice Address - Street 1:180 6TH AVE
Practice Address - Street 2:ROOM 138
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3507
Practice Address - Country:US
Practice Address - Phone:718-230-5707
Practice Address - Fax:718-230-7546
Is Sole Proprietor?:No
Enumeration Date:2008-06-29
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381990363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics