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NPI Code Detail

MEDICARE: CARMELITA A WILSON RN

MEDICARE: CARMELITA A 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
1163WS0200XSchool Registered NurseRN058184AZ

Other Identifiers

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

General Provider Information

NPI Number : 1750506770
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARMELITA A WILSON RN
Provider Business Mailing Address
First Line : 8199 KOCH FIELD RD
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1251
Country : US
Telephone Number : 928-527-1396
Fax Number :
Provider Business Practice Location Address
First Line : 3285 E SPARROW AVE
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-7794
Country : US
Telephone Number : 928-773-8152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 07/08/2007

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