Provider Demographics
NPI:1154004562
Name:WILSON, PATRICIA A (CHW)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 N LOVERS LANE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3051
Mailing Address - Country:US
Mailing Address - Phone:414-206-9126
Mailing Address - Fax:
Practice Address - Street 1:5214 N LOVERS LANE RD APT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3051
Practice Address - Country:US
Practice Address - Phone:414-206-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker