MEDICARE: MR. WILLIAM HENRY WREN

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	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1669517975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM HENRY WREN

Provider Business Mailing Address
First Line	:	2240 GATEWAY OAKS DR
Second Line	:	APT. #119
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-3219
Country	:	US
Telephone Number	:	916-531-2879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 GLENDALE LN
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2454
Country	:	US
Telephone Number	:	916-641-9595
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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