MEDICARE: DANDRIA T WILEY NP

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	363LF0000X	Family Nurse Practitioner	AP05810	LA

General Provider Information

NPI Number	:	1083841712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANDRIA T WILEY NP

Provider Business Mailing Address
First Line	:	182 HANNIBAL CT
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39530-3916
Country	:	US
Telephone Number	:	228-324-9236
Fax Number	:

Provider Business Practice Location Address
First Line	:	4018 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2749
Country	:	US
Telephone Number	:	504-897-9200
Fax Number	:	504-897-9234

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

Provider Enumeration Date	:	06/20/2009
Last Update Date	:	06/20/2009

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