MEDICARE: JANET WILSON

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	171100000X	Acupuncturist	AK001068	PA

General Provider Information

NPI Number	:	1629409818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET WILSON

Provider Business Mailing Address
First Line	:	8136 ARDLEIGH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3412
Country	:	US
Telephone Number	:	267-670-0989
Fax Number	:

Provider Business Practice Location Address
First Line	:	8136 ARDLEIGH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3412
Country	:	US
Telephone Number	:	267-670-0989
Fax Number	:

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

Provider Enumeration Date	:	12/12/2013
Last Update Date	:	12/12/2013

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Directions to “ JANET WILSON ” Practice Location

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