Provider Demographics
NPI:1447332499
Name:WILSON, BARBARA (RD)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6151 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-2317
Mailing Address - Country:US
Mailing Address - Phone:707-484-0181
Mailing Address - Fax:
Practice Address - Street 1:6151 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-2317
Practice Address - Country:US
Practice Address - Phone:707-484-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005029133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ54704OtherINDEPENDENCE BLUE CROSS
NJ3889264000OtherAMERIHEALTH