MEDICARE: WILMA NORMAN 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1770196172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILMA NORMAN RN

Provider Business Mailing Address
First Line	:	20862 LANCELOT LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-5933
Country	:	US
Telephone Number	:	714-655-7970
Fax Number	:

Provider Business Practice Location Address
First Line	:	6123 STORNOWAY DR S
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2105
Country	:	US
Telephone Number	:	714-655-7970
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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