Individual
MRS. HEATHER RENEE' WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N
Contact information
Practice address
1476 LANCASTER PIKE, LOT 28, CIRCLEVILLE, OH 43113-9487
(740) 474-5908
Mailing address
365 FOX HILL DR, CHILLICOTHE, OH 45601-7710
(740) 642-2222
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN104493
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2553759
ODJFS INDEPENDENT PROVIDE
OH
Enumeration date
12/12/2006
Last updated
07/08/2007
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