MEDICARE: REBECCA J WILSON NP-C

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	363L00000X	Nurse Practitioner	54019	NM

General Provider Information

NPI Number	:	1629553011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA J WILSON NP-C

Provider Business Mailing Address
First Line	:	27 CALLE DEL ARROYO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-4376
Country	:	US
Telephone Number	:	505-670-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-670-5763
Fax Number	:

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

Provider Enumeration Date	:	10/01/2018
Last Update Date	:	05/26/2026

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