Provider Demographics
NPI:1447859004
Name:WILSON-DAWSON, ADIA NIARA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:NIARA
Last Name:WILSON-DAWSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 BELLVISTA RD APT 24
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7666
Mailing Address - Country:US
Mailing Address - Phone:347-628-6547
Mailing Address - Fax:
Practice Address - Street 1:83 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2757
Practice Address - Country:US
Practice Address - Phone:617-665-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2335257163WP2201X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care