Individual
GWYNNE M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
45 LAZELLE RD # R, COLUMBUS, OH 43235-1429
(614) 502-7646
Mailing address
5051 HARBOR BLVD, COLUMBUS, OH 43232-6280
(614) 207-8826
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.169225.MEDS-IV
OH
Other
Enumeration date
11/24/2020
Last updated
11/24/2020
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