Individual
MS. BONNIE LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1212 HANLEY RD W, MANSFIELD, OH 44904
(419) 512-3379
(419) 884-7368
Mailing address
1212 HANLEY RD W, MANSFIELD, OH 44904
(419) 512-3377
(419) 884-7368
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN029260
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2270368
—
OH
Enumeration date
05/03/2007
Last updated
03/29/2016
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