Healthcare Provider Details

I. General information

NPI: 1316154883
Provider Name (Legal Business Name): CATHERINE J. WILSON, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 CRIMSON CANYON DR SUITE 130
LAS VEGAS NV
89128-0845
US

IV. Provider business mailing address

2660 CRIMSON CANYON DR SUITE 130
LAS VEGAS NV
89128-0845
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0306
License Number StateNV

VIII. Authorized Official

Name: CATHERINE J WILSON
Title or Position: SOLE OWNER
Credential: DPM
Phone: 702-326-2077