Provider Demographics
NPI:1386976058
Name:WILSON, MARIANNE T
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:T
Last Name: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 1:1827 MANLEY RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:NY
Mailing Address - Zip Code:14801-9781
Mailing Address - Country:US
Mailing Address - Phone:607-359-2117
Mailing Address - Fax:
Practice Address - Street 1:1827 MANLEY ROAD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:NY
Practice Address - Zip Code:14801
Practice Address - Country:US
Practice Address - Phone:607-359-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY322367163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management