Individual provider · Type 1 NPI
Bradley Russell Wilson, FNP
Family Nurse Practitioner · Detroit, MI
NPI number
1508339987
Active
Practice location
22101 Moross Rd
Detroit, MI 48236-2148
Mailing address
36251 Alfred St
New Baltimore, MI 48047-2106
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 470429662 (MI) |
Family Nurse Practitioner: Definition to come...
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About NPI 1508339987
Bradley Russell Wilson, FNP's National Provider Identifier is 1508339987, issued on Jan 8, 2019. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Detroit, MI. The record was last updated on Jan 8, 2019.