MEDICARE: MRS. WANDA LYNN DOTSON RN

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	163W00000X	Registered Nurse	715093	TX

General Provider Information

NPI Number	:	1629934476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA LYNN DOTSON RN

Provider Business Mailing Address
First Line	:	14602 KINGS HEAD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4911
Country	:	US
Telephone Number	:	281-772-5025
Fax Number	:	281-225-2667

Provider Business Practice Location Address
First Line	:	14602 KINGS HEAD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4911
Country	:	US
Telephone Number	:	281-772-5025
Fax Number	:	281-772-5025

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

Provider Enumeration Date	:	12/24/2025
Last Update Date	:	12/24/2025

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