Provider Demographics
NPI:1205657327
Name:WILSON, GUYSEYMORE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GUYSEYMORE
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E ALVORD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2215
Mailing Address - Country:US
Mailing Address - Phone:413-374-2889
Mailing Address - Fax:
Practice Address - Street 1:20 E ALVORD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2215
Practice Address - Country:US
Practice Address - Phone:413-374-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2303695163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty