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NPI Code Detail

MEDICARE: BERNICE WILSON

MEDICARE: BERNICE 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
13747P1801XPersonal Care Attendant
2172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1659925444
Entity Type Code : Individual
Provider Name (Legal Business Name) : BERNICE WILSON
Provider Business Mailing Address
First Line : 3210 W CHARLESTON BLVD STE 2
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0080
Country : US
Telephone Number :
Fax Number : 702-369-3334
Provider Business Practice Location Address
First Line : 3210 W CHARLESTON BLVD STE 2
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-0080
Country : US
Telephone Number : 702-893-2001
Fax Number : 702-369-3334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2019
Last Update Date : 06/27/2022

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Directions to “ BERNICE WILSON ” Practice Location

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