Provider Demographics
NPI:1821406026
Name:WILSON, ROSANNE B (NP)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:B
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 1:6701 AIRPORT BLVD STE A101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6767
Mailing Address - Country:US
Mailing Address - Phone:251-633-8880
Mailing Address - Fax:251-378-6222
Practice Address - Street 1:6701 AIRPORT BLVD STE A101
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6767
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:251-378-6209
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-115744363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily