MEDICARE: MS. HILDA G WIST NURSE PRACTITIONER

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	433477	TX

General Provider Information

NPI Number	:	1598047920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HILDA G WIST NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	5400 WESTHEIMER CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5353
Country	:	US
Telephone Number	:	713-627-5476
Fax Number	:	713-627-5499

Provider Business Practice Location Address
First Line	:	5400 WESTHEIMER CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5353
Country	:	US
Telephone Number	:	713-627-5476
Fax Number	:	713-627-5499

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	10/29/2014

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