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NPI Code Detail

MEDICARE: MR. WILLIAM M WILSON RN

MEDICARE: MR. WILLIAM M WILSON RN
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
1163WA0400XAddiction (Substance Use Disorder) Registered NurseR0080272OK

General Provider Information

NPI Number : 1720200058
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM M WILSON RN
Provider Business Mailing Address
First Line : 700 NW 17TH ST APT 10
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73103-2129
Country : US
Telephone Number : 405-525-2525
Fax Number :
Provider Business Practice Location Address
First Line : 1215 NW 25TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73106-5629
Country : US
Telephone Number : 405-525-2525
Fax Number : 405-525-3108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 07/08/2007

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