Provider Demographics
NPI:1659994648
Name:WILSON-NIXA, ANDREE
Entity Type:Individual
Prefix:
First Name:ANDREE
Middle Name:
Last Name:WILSON-NIXA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15203 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-1386
Mailing Address - Country:US
Mailing Address - Phone:574-855-0687
Mailing Address - Fax:
Practice Address - Street 1:15203 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1386
Practice Address - Country:US
Practice Address - Phone:574-855-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2391018163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics