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NPI Code Detail

MEDICARE: MRS. TERESA ANN WILSON

MEDICARE: MRS. TERESA ANN WILSON
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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1700140480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TERESA ANN WILSON
Provider Business Mailing Address
First Line : 3150 S NELLIS BLVD APT 1189
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7537
Country : US
Telephone Number : 559-790-8842
Fax Number :
Provider Business Practice Location Address
First Line : 3150 S NELLIS BLVD APT 1189
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7537
Country : US
Telephone Number : 559-790-8842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2012
Last Update Date : 06/27/2012

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Directions to “ MRS. TERESA ANN WILSON ” Practice Location

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