MEDICARE: ANNIE LUE WILSON-HOWARD LMT

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	225700000X	Massage Therapist	NVMT2301	NV

General Provider Information

NPI Number	:	1023514742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE LUE WILSON-HOWARD LMT

Provider Business Mailing Address
First Line	:	1437 E RENO AVE UNIT A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4726
Country	:	US
Telephone Number	:	702-936-2827
Fax Number	:

Provider Business Practice Location Address
First Line	:	3742 E TROPICANA AVE STE 1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7355
Country	:	US
Telephone Number	:	702-936-2827
Fax Number	:

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

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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