MEDICARE: ELLEN ROSSER WILSON AUD

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	237700000X	Hearing Instrument Specialist	588	NC
2	231H00000X	Audiologist	2126	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2126	OTHER	AUDIOLOGIST LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598931370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ROSSER WILSON AUD

Provider Business Mailing Address
First Line	:	1915 K M WICKER MEMORIAL DR
Second Line	:	CENTRAL CAROLINA ENT ASSOCIATES
City	:	SANFORD
State	:	NC
Zip	:	27330-5070
Country	:	US
Telephone Number	:	919-774-6829
Fax Number	:	919-775-2327

Provider Business Practice Location Address
First Line	:	1915 K M WICKER MEMORIAL DR
Second Line	:	CENTRAL CAROLINA ENT ASSOCIATES
City	:	SANFORD
State	:	NC
Zip	:	27330-5070
Country	:	US
Telephone Number	:	919-774-6829
Fax Number	:	919-775-2327

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/05/2026

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