Lisa Marie Wilson, NP

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

605899-1 Issued in NY

Practice address

2760 Monroe Ave Ste 401B
Rochester, NY 14618-4116

Phone

(585) 397-3752

NPI assigned

Jun 22, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Liverpool Family Care Medicine, PLLC

  • Emergency Medicine Physician
  • Liverpool, NY
  • NPI 1568816809
  NPD
• Muncie Allergy Center. P.S.C.

  • Allergy & Immunology Physician
  • Muncie, IN
  • NPI 1295857621
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1134415755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 500",
            "city": "ELLICOTTVILLE",
            "state": "NY",
            "postal_code": "147310500",
            "telephone_number": "716-699-9032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 MONROE AVE STE 401B",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146184116",
            "telephone_number": "585-397-3752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1288 Telephone Rd",
            "address_purpose": "LOCATION",
            "city": "Rush",
            "state": "NY",
            "postal_code": "145439739",
            "country_code": "US",
            "telephone_number": "585-309-9987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-22",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "345130",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "605899-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1134415755",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katharine R Wilson, MSPT, CHT
• Kathleen A Wilson
• Keith Raymond Wilson, LMHC
• Kirsten Wilson, CASAC
• Le Keyah Wilson, MD
• Lorilyn A Wilson, LCSW
• Mateakka Sharrell Wilson
• Matthew Wilson, MD
• Melissa Ann Wilson, MS ATC
• Michael Francis Wilson

• Registered Nurse in Rochester, NY
• Providers in Rochester, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.