Provider Demographics
NPI:1366074759
Name:WILSON, RHENDA RAE (RN, BSN)
Entity type:Individual
Prefix:
First Name:RHENDA
Middle Name:RAE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-2580
Mailing Address - Country:US
Mailing Address - Phone:775-738-4158
Mailing Address - Fax:775-777-7488
Practice Address - Street 1:215 BLUFFS AVE STE 200
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2465
Practice Address - Country:US
Practice Address - Phone:775-777-8477
Practice Address - Fax:775-777-7488
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821174163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse