Active NPI
Judith Ruth Wilson, NP
- Adult Health Nurse Practitioner
- Long Beach, CA
National Provider Identifier
1275736191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 1340
- Practice address
- 1645 Clark Ave Unit 116
Long Beach, CA 90815-3807 - Phone
- (562) 961-9146
- Fax
- (562) 961-9146
- NPI assigned
- Jun 7, 2007
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 1340 | CA | Primary |
Addresses
Primary practice location
1645 Clark Ave Unit 116
Long Beach, CA 90815-3807
Mailing address
1645 Clark Ave Unit 116
Long Beach, CA 90815-3807
Phone (562) 961-9146
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
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1340 | CA | MD | Speech/Language/Hearing Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415750400000",
"number": "1275736191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1645 CLARK AVE UNIT 116",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908153807",
"telephone_number": "562-961-9146",
"fax_number": "562-961-9146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1645 CLARK AVE UNIT 116",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908153807",
"telephone_number": "562-961-9146",
"fax_number": "562-961-9146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JUDITH",
"middle_name": "RUTH",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-07",
"last_updated": "2014-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "CA",
"license": "1340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.