Provider Demographics
NPI:1437939964
Name:WILSON, SIMONE ALYSSA (FNP)
Entity Type:Individual
Prefix:MS
First Name:SIMONE
Middle Name:ALYSSA
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PERIWINKLE CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7759
Mailing Address - Country:US
Mailing Address - Phone:302-535-4964
Mailing Address - Fax:
Practice Address - Street 1:39 PERIWINKLE CT
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7759
Practice Address - Country:US
Practice Address - Phone:302-535-4964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0012484363LF0000X
MDAC005898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily