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NPI Code Detail

MEDICARE: DONNA C. WILSON FNP

MEDICARE:   DONNA C. WILSON  FNP
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
1363LF0000XFamily Nurse Practitioner076398MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2190892OTHERBLUE CROSS OF MO

General Provider Information

NPI Number : 1164523403
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA C. WILSON FNP
Provider Business Mailing Address
First Line : PO BOX 4046
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65808-4046
Country : US
Telephone Number : 417-269-5712
Fax Number : 417-269-7567
Provider Business Practice Location Address
First Line : 510 HIGHWAY 32
Second Line :
City : LEBANON
State : MO
Zip : 65536-5303
Country : US
Telephone Number : 417-269-2278
Fax Number : 417-269-2274
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 05/07/2019

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Directions to “ DONNA C. WILSON FNP” Practice Location

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