MEDICARE: MARIAN WILSON ROWLAND APN

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	128026	TN
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	128935	IA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14993	TN
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	G128935	IA

General Provider Information

NPI Number	:	1073627485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN WILSON ROWLAND APN

Provider Business Mailing Address
First Line	:	940 S OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-2601
Country	:	US
Telephone Number	:	423-479-5454
Fax Number	:	423-339-3421

Provider Business Practice Location Address
First Line	:	940 S OCOEE ST
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-2601
Country	:	US
Telephone Number	:	423-479-5454
Fax Number	:	423-339-3421

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	06/10/2016

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