Provider Demographics
NPI:1689345902
Name:WILSON, AMY (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 W COLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9431
Mailing Address - Country:US
Mailing Address - Phone:207-780-6565
Mailing Address - Fax:208-878-6565
Practice Address - Street 1:22 W COLE RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9430
Practice Address - Country:US
Practice Address - Phone:207-780-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP211446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily