MEDICARE: MS. PEGGYE ANN WILKERSON RN

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	163WA2000X	Administrator Registered Nurse	R12902	AR

General Provider Information

NPI Number	:	1437152022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PEGGYE ANN WILKERSON RN

Provider Business Mailing Address
First Line	:	7500 SECURITY BLVD
Second Line	:	MAIL STOP S2-12-25
City	:	BALTIMORE
State	:	MD
Zip	:	21244
Country	:	US
Telephone Number	:	410-786-4857
Fax Number	:	410-786-6371

Provider Business Practice Location Address
First Line	:	7500 SECURITY BLVD
Second Line	:	MAIL STOP S2-12-25
City	:	BALTIMORE
State	:	MD
Zip	:	21244
Country	:	US
Telephone Number	:	410-786-4857
Fax Number	:	410-786-6371

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/04/2007

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