Individual
GINA WILMS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2400 SOMRACK DR, WILLOUGHBY, OH 44094-9603
(440) 946-0009
Mailing address
1352 STATE ROUTE 45, AUSTINBURG, OH 44010-9749
(440) 275-3919
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
301072
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301072
—
OH
Enumeration date
05/11/2006
Last updated
07/09/2007
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