Active NPI
Carlie Wilson, MSN, PRN, AGCNS-BC
- Gerontology Clinical Nurse Specialist
- Livonia, MI
National Provider Identifier
1013596139
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Clinical Nurse Specialist
- License
- 2021000750
- Practice address
- 19360 Shadyside St
Livonia, MI 48152-1319 - Phone
- (734) 678-7186
- NPI assigned
- Apr 6, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Clinical Nurse Specialist | 364SG0600X | 2021000750 | MI | Primary |
Addresses
Primary practice location
19360 Shadyside St
Livonia, MI 48152-1319
Mailing address
19360 Shadyside St
Livonia, MI 48152-1319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2021000750 | MI | MD | Gerontology Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617667200000",
"number": "1013596139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19360 SHADYSIDE ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19360 SHADYSIDE ST",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521319",
"telephone_number": "734-678-7186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CARLIE",
"credential": "MSN, PRN, AGCNS-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-06",
"last_updated": "2021-04-06",
"certification_date": "2021-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "364SG0600X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Gerontology",
"state": "MI",
"license": "2021000750",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.