MEDICARE: KAREN ELIZABETH WILSON FNP

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	363LF0000X	Family Nurse Practitioner	FNP 19173	CA

General Provider Information

NPI Number	:	1942508106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN ELIZABETH WILSON FNP

Provider Business Mailing Address
First Line	:	8501 WEST RD
Second Line	:
City	:	REDWOOD VALLEY
State	:	CA
Zip	:	95470-9583
Country	:	US
Telephone Number	:	707-485-6900
Fax Number	:	707-485-6909

Provider Business Practice Location Address
First Line	:	8501 WEST RD
Second Line	:
City	:	REDWOOD VALLEY
State	:	CA
Zip	:	95470-9583
Country	:	US
Telephone Number	:	707-485-6900
Fax Number	:	707-485-6909

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

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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