Individual provider Active NPI

Elizabeth Wilson, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1902747975
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP035331 Issued in PA
Practice address
111 S 11TH St
Philadelphia, PA 19107-4870
Phone
(215) 955-6000
NPI assigned
Apr 3, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP035331 PA Primary

Addresses

Primary practice location

111 S 11TH St
Philadelphia, PA 19107-4870

Mailing address

111 S 11TH St
Philadelphia, PA 19107-4870

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260624002246 PA Practitioner - Nurse Practitioner 9436622115 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1101 Market St
Philadelphia, PA 19107-2955

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SP035331PAMDFamily Nurse Practitioner

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1775174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1902747975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191074870",
            "telephone_number": "215-955-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "ELIZABETH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-04-03",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP035331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.