Provider Demographics
NPI:1912218041
Name:WILSON, JEMMA (RN)
Entity Type:Individual
Prefix:MS
First Name:JEMMA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 JUDITH LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3332
Mailing Address - Country:US
Mailing Address - Phone:516-812-9791
Mailing Address - Fax:516-812-9791
Practice Address - Street 1:109 JUDITH LN
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3332
Practice Address - Country:US
Practice Address - Phone:516-812-9791
Practice Address - Fax:516-812-9791
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY627187163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse