Provider Demographics
NPI:1790087526
Name:WILSON, ADRIA A
Entity Type:Individual
Prefix:
First Name:ADRIA
Middle Name:A
Last Name:WILSON
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 1:5880 STATE ROUTE 434
Mailing Address - Street 2:APT. D-6
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-2467
Mailing Address - Country:US
Mailing Address - Phone:607-429-9556
Mailing Address - Fax:
Practice Address - Street 1:5880 STATE ROUTE 434
Practice Address - Street 2:APT. D-6
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-2467
Practice Address - Country:US
Practice Address - Phone:607-429-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor