Provider Demographics
NPI:1467247452
Name:WILSON, CARMEN L (FNP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:WILSON
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:BEGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 N MOLLISON AVE # 203
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-6159
Mailing Address - Country:US
Mailing Address - Phone:619-354-4694
Mailing Address - Fax:
Practice Address - Street 1:505 N MOLLISON AVE
Practice Address - Street 2:#203
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021
Practice Address - Country:US
Practice Address - Phone:619-354-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021008364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health