Provider Demographics
NPI:1578939682
Name:WILSON, JAMEELAH (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAMEELAH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7316 E SOUTHERN AVE # 6091
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-2783
Mailing Address - Country:US
Mailing Address - Phone:602-552-2930
Mailing Address - Fax:
Practice Address - Street 1:1237 S VAL VISTA DR # 117-118
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6401
Practice Address - Country:US
Practice Address - Phone:602-552-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily