Provider Demographics
NPI:1871214056
Name:WILSON, GLADYS (CPRS)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 W SHERMAN AVE STE 4A&B
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6931
Mailing Address - Country:US
Mailing Address - Phone:856-839-2482
Mailing Address - Fax:
Practice Address - Street 1:1051 W SHERMAN AVE STE 4A&B
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6931
Practice Address - Country:US
Practice Address - Phone:856-839-2482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist