Provider Demographics
NPI:1811618762
Name:WILSON, MARIAHA DAYLEON (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MARIAHA
Middle Name:DAYLEON
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S BRAESWOOD BLVD STE 5330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4466
Mailing Address - Country:US
Mailing Address - Phone:903-526-9887
Mailing Address - Fax:
Practice Address - Street 1:1919 S BRAESWOOD BLVD STE 5330
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4466
Practice Address - Country:US
Practice Address - Phone:832-827-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058478363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics