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NPI Code Detail

MEDICARE: MIRACLE ELAINE WILSON

MEDICARE: MIRACLE ELAINE WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistCA
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1003431370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRACLE ELAINE WILSON
Provider Business Mailing Address
First Line : 8912 VOLUNTEER LN
Second Line :
City : SACRAMENTO
State : CA
Zip : 95826-3221
Country : US
Telephone Number : 916-344-0199
Fax Number :
Provider Business Practice Location Address
First Line : 8912 VOLUNTEER LN
Second Line :
City : SACRAMENTO
State : CA
Zip : 95826-3221
Country : US
Telephone Number : 916-344-0199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2020
Last Update Date : 01/15/2026

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Directions to “ MIRACLE ELAINE WILSON ” Practice Location

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