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NPI Code Detail

MEDICARE: MS. SUMMER ROSE WILSON MS, ATC, LAT

MEDICARE: MS. SUMMER ROSE WILSON MS, ATC, LAT
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
12255A2300XAthletic TrainerATH.200277LA

General Provider Information

NPI Number : 1033343942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUMMER ROSE WILSON MS, ATC, LAT
Provider Business Mailing Address
First Line : 1713 ALVAR ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70117-5128
Country : US
Telephone Number : 512-636-6989
Fax Number :
Provider Business Practice Location Address
First Line : 1713 ALVAR ST
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70117-5128
Country : US
Telephone Number : 512-636-6989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2009
Last Update Date : 10/07/2022

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