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NPI Code Detail

MEDICARE: THERESA WILHELM NP

MEDICARE: THERESA WILHELM 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
1363L00000XNurse PractitionerSP012765PA
2363L00000XNurse PractitionerR097837MD

General Provider Information

NPI Number : 1184061053
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA WILHELM NP
Provider Business Mailing Address
First Line : 347 BALLENGER CENTER DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7095
Country : US
Telephone Number : 301-663-5181
Fax Number :
Provider Business Practice Location Address
First Line : 347 BALLENGER CENTER DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7095
Country : US
Telephone Number : 301-663-5181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2013
Last Update Date : 05/19/2016

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