Individual
AMY M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
319 W LORAIN ST, OBERLIN, OH 44074-1027
(440) 775-1881
(440) 774-5707
Mailing address
PO BOX 636461, CINCINNATI, OH 45263-6461
(440) 988-1009
(440) 988-1225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002742
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0236248
—
OH
Enumeration date
03/31/2008
Last updated
10/04/2010
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