Provider Demographics
NPI:1760014690
Name:WILSON, GABRIELA CRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:CRISTINA
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 CARPENTER RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1108
Mailing Address - Country:US
Mailing Address - Phone:734-971-1073
Mailing Address - Fax:734-971-8545
Practice Address - Street 1:2650 CARPENTER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1108
Practice Address - Country:US
Practice Address - Phone:734-971-1073
Practice Address - Fax:734-971-8545
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty