MEDICARE: CATHERINE WILSON 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	363L00000X	Nurse Practitioner	R047021	ME

General Provider Information

NPI Number	:	1295893022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE WILSON NP

Provider Business Mailing Address
First Line	:	118 NORTHPORT AVE
Second Line	:	P.O. BOX 287
City	:	BELFAST
State	:	ME
Zip	:	04915-6009
Country	:	US
Telephone Number	:	207-338-0990
Fax Number	:	207-338-0590

Provider Business Practice Location Address
First Line	:	2399 ATLANTIC HWY
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849
Country	:	US
Telephone Number	:	207-236-4851
Fax Number	:	207-236-0776

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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