MEDICARE: DR. CATHERINE J WILSON DPM

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	213E00000X	Podiatrist	0306	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720179716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE J WILSON DPM

Provider Business Mailing Address
First Line	:	2660 CRIMSON CANYON DR
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0845
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

Provider Business Practice Location Address
First Line	:	2660 CRIMSON CANYON DR
Second Line	:	SUITE 130
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0845
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/09/2015

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Directions to “ DR. CATHERINE J WILSON DPM” Practice Location

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