Provider Demographics
NPI:1952533788
Name:THOMAS-WILSON, SANDRA
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:THOMAS-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 193RD ST
Mailing Address - Street 2:APT 6C
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2040
Mailing Address - Country:US
Mailing Address - Phone:718-413-7272
Mailing Address - Fax:
Practice Address - Street 1:8819 193RD ST
Practice Address - Street 2:APT 6C
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2040
Practice Address - Country:US
Practice Address - Phone:718-413-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265414164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse