Provider Demographics
NPI:1760081988
Name:WILSON, CHRISTINE J (RN, HEC-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:J
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, HEC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14622 VENTURA BLVD # 2135
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3600
Mailing Address - Country:US
Mailing Address - Phone:818-389-8512
Mailing Address - Fax:
Practice Address - Street 1:15007 HARTLAND ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3714
Practice Address - Country:US
Practice Address - Phone:818-389-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA319649163WC0400X
174V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174V00000XOther Service ProvidersClinical Ethicist
No163WC0400XNursing Service ProvidersRegistered NurseCase Management