MEDICARE: RONNA LAO-WILSON MD

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	207Q00000X	Family Medicine Physician	21437	NV

General Provider Information

NPI Number	:	1568969871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONNA LAO-WILSON MD

Provider Business Mailing Address
First Line	:	190 W 6TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-4502
Country	:	US
Telephone Number	:	775-328-9220
Fax Number	:	775-328-9496

Provider Business Practice Location Address
First Line	:	190 W 6TH ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89503-4502
Country	:	US
Telephone Number	:	775-328-9220
Fax Number	:	775-328-9496

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

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	12/05/2023

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