Provider Demographics
NPI:1619059680
Name:WILSON, DOLORES A (NP)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:ANITA
Other - Last Name:TORGERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:414 UNION ST
Mailing Address - Street 2:ATTN: HUMAN RESOURCES
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1118
Mailing Address - Country:US
Mailing Address - Phone:518-374-5353
Mailing Address - Fax:518-377-2517
Practice Address - Street 1:414 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1118
Practice Address - Country:US
Practice Address - Phone:518-374-5353
Practice Address - Fax:518-374-8234
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331131-1363LF0000X
NYF360014-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY346854OtherMVP
NY0330F331131Medicaid
NY0330F331131Medicaid
NYBB4842Medicare ID - Type Unspecified