Individual
SUZANNE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
991 VALLEY DALE DR, XENIA, OH 45385-9659
(937) 474-0475
Mailing address
991 VALLEY DALE DR, XENIA, OH 45385-9659
(937) 474-0475
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
11/27/2020
Last updated
11/27/2020
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