Individual
NICOLE LYNN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
2054 MAGEE ST, DOWN, LAKEWOOD, OH 44107-5238
(216) 849-1895
Mailing address
2054 MAGEE ST, DOWN, LAKEWOOD, OH 44107-5238
(216) 849-1895
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401835840316
OH
Other
Enumeration date
03/20/2017
Last updated
03/20/2017
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