Provider Demographics
NPI:1184491201
Name:WILSON, KATHRYN ROSE (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:19 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7160
Mailing Address - Country:US
Mailing Address - Phone:785-770-4379
Mailing Address - Fax:978-345-4730
Practice Address - Street 1:19 PIERCE AVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7160
Practice Address - Country:US
Practice Address - Phone:978-577-0437
Practice Address - Fax:978-345-4730
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-01-25
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Provider Licenses
StateLicense IDTaxonomies
MARN2310642163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics