MEDICARE: MS. GINA ANN WILSON APRN

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	363LA2200X	Adult Health Nurse Practitioner	577549	TX

General Provider Information

NPI Number	:	1134541782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GINA ANN WILSON APRN

Provider Business Mailing Address
First Line	:	7139 KENNY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3124
Country	:	US
Telephone Number	:	214-455-6149
Fax Number	:

Provider Business Practice Location Address
First Line	:	7139 KENNY LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-3124
Country	:	US
Telephone Number	:	214-455-6149
Fax Number	:

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

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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