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NPI Code Detail

MEDICARE: HEIKE WILSON

MEDICARE: HEIKE WILSON
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
1363LF0000XFamily Nurse PractitionerSP015167PA

General Provider Information

NPI Number : 1912378258
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIKE WILSON
Provider Business Mailing Address
First Line : 10 BROOKRIDGE DR
Second Line :
City : SWEDESBORO
State : NJ
Zip : 08085
Country : US
Telephone Number : 267-625-8425
Fax Number :
Provider Business Practice Location Address
First Line : 5001 TOWNSHIP LINE RD
Second Line :
City : DREXEL HILL
State : PA
Zip : 19026-4821
Country : US
Telephone Number : 610-623-1393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2015
Last Update Date : 11/15/2017

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Directions to “ HEIKE WILSON ” Practice Location

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