MEDICARE: MRS. NATASHA ANTOINETTE WILSON FNP

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
1	363L00000X	Nurse Practitioner	112288	NE

General Provider Information

NPI Number	:	1083108096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATASHA ANTOINETTE WILSON FNP

Provider Business Mailing Address
First Line	:	988102 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-8102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	EMILE @ 42ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-2040
Country	:	US
Telephone Number	:	402-559-4015
Fax Number	:	402-559-5581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2018
Last Update Date	:	06/22/2018

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