Provider Demographics
NPI:1518230564
Name:MORTON-WILSON, DOROTHY ELAINE (NP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELAINE
Last Name:MORTON-WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ELAINE
Other - Last Name:MORTON WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, MSN, FNP-C
Mailing Address - Street 1:275 W MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5641
Mailing Address - Country:US
Mailing Address - Phone:510-752-1000
Mailing Address - Fax:
Practice Address - Street 1:275 W MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-752-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 21387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily