Provider Demographics
NPI:1881850774
Name:WILSON, RACHEL REMA (LPN)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:REMA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 LEFFERTS AVE
Mailing Address - Street 2:APARTMENT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4549
Mailing Address - Country:US
Mailing Address - Phone:718-773-5324
Mailing Address - Fax:
Practice Address - Street 1:480 LEFFERTS AVE
Practice Address - Street 2:APART 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-4549
Practice Address - Country:US
Practice Address - Phone:718-773-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187400164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY187400OtherLPN