Active NPI
Chantal Tanisha Marie Wilson
- Registered Nurse
- Orange, NJ
National Provider Identifier
1023442407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 670331
- Practice address
- 765 Vose Ave
Apt B10
Orange, NJ 07050-1060 - Phone
- (973) 943-3728
- NPI assigned
- Aug 21, 2013
- Last updated
- Aug 21, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 670331 | NY | Primary |
Addresses
Primary practice location
765 Vose Ave
Apt B10
Orange, NJ 07050-1060
Mailing address
765 Vose Ave
Apt B10
Orange, NJ 07050-1060
Phone (973) 943-3728
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 670331 | NY | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1377043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1377043200000",
"number": "1023442407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "765 VOSE AVE",
"address_2": "APT B10",
"city": "ORANGE",
"state": "NJ",
"postal_code": "070501060",
"telephone_number": "973-943-3728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "765 VOSE AVE",
"address_2": "APT B10",
"city": "ORANGE",
"state": "NJ",
"postal_code": "070501060",
"telephone_number": "973-943-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHANTAL",
"middle_name": "TANISHA MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-21",
"last_updated": "2013-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "670331",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.