Provider Demographics
NPI:1023341484
Name:WILSON, HADON (LPN)
Entity type:Individual
Prefix:
First Name:HADON
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2203
Mailing Address - Country:US
Mailing Address - Phone:718-638-1933
Mailing Address - Fax:
Practice Address - Street 1:219 HALSEY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2203
Practice Address - Country:US
Practice Address - Phone:718-638-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247487164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247487OtherOFFICE OF PROFESSIONS - LPN LICENSE