Provider Demographics
NPI:1205171998
Name:WILSON-SIMPSON, COLETTE
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:WILSON-SIMPSON
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 1:27 PILOT STREET
Mailing Address - Street 2:
Mailing Address - City:NEW AMSTERDAM
Mailing Address - State:BERBICE
Mailing Address - Zip Code:11208
Mailing Address - Country:GY
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:492 BERRIMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4414
Practice Address - Country:US
Practice Address - Phone:917-417-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY629465-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse