MEDICARE: DR. LINDSAY HELENA WILSON MD

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	207N00000X	Dermatology Physician	7771633-1205	UT

General Provider Information

NPI Number	:	1396068342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSAY HELENA WILSON MD

Provider Business Mailing Address
First Line	:	3845 WEST 4700 SOUTH
Second Line	:	IHC TAYLORSVILLE CLINIC
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129
Country	:	US
Telephone Number	:	801-840-2000
Fax Number	:	801-840-2179

Provider Business Practice Location Address
First Line	:	3845 WEST 4700 SOUTH
Second Line	:	INTERMOUNTAIN HEALTHCARE TAYLORSVILLE CLINIC
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84129
Country	:	US
Telephone Number	:	801-840-2000
Fax Number	:	801-840-2179

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

Provider Enumeration Date	:	03/04/2010
Last Update Date	:	05/28/2014

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