MEDICARE: WILMAR AUSTERO GARCIA FNP-C

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	207N00000X	Dermatology Physician	A164470	IA

General Provider Information

NPI Number	:	1740953439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILMAR AUSTERO GARCIA FNP-C

Provider Business Mailing Address
First Line	:	359 W PINEHURST TRL
Second Line	:
City	:	DAKOTA DUNES
State	:	SD
Zip	:	57049-5234
Country	:	US
Telephone Number	:	712-204-9094
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 PIERCE ST STE 300
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3765
Country	:	US
Telephone Number	:	712-279-3637
Fax Number	:

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

Provider Enumeration Date	:	07/28/2021
Last Update Date	:	07/28/2021

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