MEDICARE: TAYLER 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
1	163W00000X	Registered Nurse	R45531	ND

General Provider Information

NPI Number	:	1962011239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLER WILSON

Provider Business Mailing Address
First Line	:	300 W CENTURY AVE STE B
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-4900
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W CENTURY AVE STE B
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-4900
Country	:	US
Telephone Number	:	877-691-0015
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	09/05/2024

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Directions to “ TAYLER WILSON ” Practice Location

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