MEDICARE: MRS. EMILY ANNE WIMSATT 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
1	163WC0200X	Critical Care Medicine Registered Nurse	51124	WY
2	163WE0003X	Emergency Registered Nurse	51124	WY
3	163WX0003X	Inpatient Obstetric Registered Nurse	51124	WY
4	163WM0705X	Medical-Surgical Registered Nurse	51124	WY

General Provider Information

NPI Number	:	1972377059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY ANNE WIMSATT RN

Provider Business Mailing Address
First Line	:	1563 CEDAR AVE
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5434
Country	:	US
Telephone Number	:	605-377-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1563 CEDAR AVE
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-5434
Country	:	US
Telephone Number	:	605-377-7327
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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