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NPI Code Detail

MEDICARE: TERELL WILSON

MEDICARE: TERELL 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
1372600000XAdult Companion
23747P1801XPersonal Care Attendant
3372500000XChore Provider

General Provider Information

NPI Number : 1013805043
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERELL WILSON
Provider Business Mailing Address
First Line : 1412 NEPTUNE DR
Second Line :
City : CARTER LAKE
State : IA
Zip : 51510-1443
Country : US
Telephone Number : 402-301-9851
Fax Number :
Provider Business Practice Location Address
First Line : 1412 NEPTUNE DR
Second Line :
City : CARTER LAKE
State : IA
Zip : 51510-1443
Country : US
Telephone Number : 402-301-9851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2025
Last Update Date : 06/26/2025

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Directions to “ TERELL WILSON ” Practice Location

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