MEDICARE: KIANA RACHELE WILBERN LSW

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	104100000X	Social Worker	SW141264	PA

General Provider Information

NPI Number	:	1649037177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIANA RACHELE WILBERN LSW

Provider Business Mailing Address
First Line	:	3544 N PROGRESS AVE STE 107
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-9638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3544 N PROGRESS AVE STE 107
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-9638
Country	:	US
Telephone Number	:	717-315-7474
Fax Number	:

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

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	03/01/2024

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Directions to “ KIANA RACHELE WILBERN LSW” Practice Location

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