MEDICARE: MRS. BOGUSLAWA BORNIK WILSON RMHI

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1487137246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BOGUSLAWA BORNIK WILSON RMHI

Provider Business Mailing Address
First Line	:	14444 N BRANCH RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9032
Country	:	US
Telephone Number	:	941-345-7446
Fax Number	:

Provider Business Practice Location Address
First Line	:	9050 58TH DR E
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-6104
Country	:	US
Telephone Number	:	941-229-3507
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	09/07/2018

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Directions to “ MRS. BOGUSLAWA BORNIK WILSON RMHI” Practice Location

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