MEDICARE: NYA WIELBON

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	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1477284560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYA WIELBON

Provider Business Mailing Address
First Line	:	3015 GREENRIDGE DR APT 39
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-6021
Country	:	US
Telephone Number	:	716-279-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 GREENRIDGE DR APT 39
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-6021
Country	:	US
Telephone Number	:	716-279-9643
Fax Number	:

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

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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Directions to “ NYA WIELBON ” Practice Location

Language	Start Address	Practice Location

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