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NPI Code Detail

MEDICARE: KIMBERLY GRACE WILSON CSTFA

MEDICARE: KIMBERLY GRACE WILSON CSTFA
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
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1811375801
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY GRACE WILSON CSTFA
Provider Business Mailing Address
First Line : 1950 CARLIN ST
Second Line :
City : RENO
State : NV
Zip : 89503-4023
Country : US
Telephone Number : 830-313-4403
Fax Number :
Provider Business Practice Location Address
First Line : 1155 MILL ST
Second Line :
City : RENO
State : NV
Zip : 89502-1576
Country : US
Telephone Number : 775-982-4280
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2015
Last Update Date : 05/11/2015

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Directions to “ KIMBERLY GRACE WILSON CSTFA” Practice Location

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