Provider Demographics
NPI:1013634146
Name:WILSON-HORTON, ALICE BEATRICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:BEATRICE
Last Name:WILSON-HORTON
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 1:1330 SIOUX RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1614
Mailing Address - Country:US
Mailing Address - Phone:908-307-4489
Mailing Address - Fax:
Practice Address - Street 1:401 HORSHAM RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2013
Practice Address - Country:US
Practice Address - Phone:267-422-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2021039269363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology