Provider Demographics
NPI:1548543606
Name:MAGLOIRE-WILSON, MARYANN (FNP)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MAGLOIRE-WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2839
Mailing Address - Country:US
Mailing Address - Phone:908-684-1051
Mailing Address - Fax:
Practice Address - Street 1:65 MALLARD DR
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2839
Practice Address - Country:US
Practice Address - Phone:908-684-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00345900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily