1881698777 NPI number — DR. ROSEMARIE A WILSON DC

Table of content: DR. ROSEMARIE A WILSON DC (NPI 1881698777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881698777 NPI number — DR. ROSEMARIE A WILSON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILSON
Provider First Name:
ROSEMARIE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881698777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
03/27/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 N VINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67042-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-321-2273
Provider Business Mailing Address Fax Number:
316-321-2225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67042-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-321-2273
Provider Business Practice Location Address Fax Number:
316-321-2225
Provider Enumeration Date:
06/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01-04137 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)