Sally Wilson, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13414 Issued in CA

Practice address

4456 Dawes Ave
Culver City, CA 90230

Phone

(310) 319-4503

NPI assigned

Mar 21, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: swilson53381@direct.uclahealth.org

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

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1255673893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4456 DAWES AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902305124",
            "telephone_number": "310-319-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4456 DAWES AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "90230",
            "telephone_number": "310-319-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SALLY",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-21",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WW0101X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Women's Health Care, Ambulatory",
            "state": "CA",
            "license": "514467",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "13414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Williamson
• Corshanae Davene Willis
• Michael Dwayne Willis
• Jean Afric Wills, LVN
• Robert James Wilmarth
• Scott Wimberly
• Lauren Lee Wing, PH.D.
• Kyla Winner-Connor
• Kevin Jacob Winston
• Wirtschafter Dental Corporation

• Family Nurse Practitioner in Culver City, CA
• Providers in Culver City, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.

Verify at the official NPI Registry.