Provider Demographics
NPI:1710208335
Name:WILSON, AMY ROSE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROSE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11974 SSG RIVERS CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79908-3238
Mailing Address - Country:US
Mailing Address - Phone:785-532-8944
Mailing Address - Fax:
Practice Address - Street 1:11974 SSG RIVERS CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79908-3238
Practice Address - Country:US
Practice Address - Phone:785-532-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX776997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse