Provider Demographics
NPI:1629523519
Name:WILSON, EMILY BERNICE (RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:BERNICE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MANCHESTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2895
Mailing Address - Country:US
Mailing Address - Phone:845-452-1700
Mailing Address - Fax:
Practice Address - Street 1:44-46 FOSTER RD
Practice Address - Street 2:BLDG B
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6178
Practice Address - Country:US
Practice Address - Phone:845-452-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22717811163W00000X
NY382817363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse