MEDICARE: MRS. DEBRA ANN WILHELM CRNP

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	363LP0200X	Pediatric Nurse Practitioner	26NN07804900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740230952	OTHER	NJ	GROUP PRACTICE NPI

General Provider Information

NPI Number	:	1568511715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANN WILHELM CRNP

Provider Business Mailing Address
First Line	:	6601 VENTNOR AVENUE
Second Line	:	TROY AVENUE ST14
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406
Country	:	US
Telephone Number	:	609-487-6507
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 VENTNOR AVE
Second Line	:	TROY AVENUE ST14
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-2167
Country	:	US
Telephone Number	:	609-487-6507
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	12/05/2014

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