MEDICARE: AMY ROSE WILSON 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	776997	TX

General Provider Information

NPI Number	:	1710208335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ROSE WILSON RN

Provider Business Mailing Address
First Line	:	11974 SSG RIVERS CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79908-3238
Country	:	US
Telephone Number	:	785-532-8944
Fax Number	:

Provider Business Practice Location Address
First Line	:	11974 SSG RIVERS CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79908-3238
Country	:	US
Telephone Number	:	785-532-8944
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	06/17/2010

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