Provider Demographics
NPI:1457765497
Name:WILSON, MERCEDES (DVM)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6803 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-6009
Mailing Address - Country:US
Mailing Address - Phone:718-748-1047
Mailing Address - Fax:718-680-8969
Practice Address - Street 1:6803 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-6009
Practice Address - Country:US
Practice Address - Phone:718-748-1047
Practice Address - Fax:718-680-8969
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011959174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian