MEDICARE: KAREN 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
1	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1710407184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN WILSON

Provider Business Mailing Address
First Line	:	138 NEW MOHAWK RD STE 200
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-3248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 NEW MOHAWK RD STE 200
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-3248
Country	:	US
Telephone Number	:	530-478-0900
Fax Number	:	530-478-0982

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	04/17/2025

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