Provider Demographics
NPI:1205531407
Name:WILSON, BRITTANY E (LPN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:E
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 1:638 LISBON AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1214
Mailing Address - Country:US
Mailing Address - Phone:716-400-3344
Mailing Address - Fax:
Practice Address - Street 1:638 LISBON AVE UPPR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1214
Practice Address - Country:US
Practice Address - Phone:716-400-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338376164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse