Basic Information
| Provider Information | |||||||||
| NPI: | 1467120923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2652 KULL RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431307707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406870835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2652 KULL RD | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431307707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406870835 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2021 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LPN.117358.MEDS | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.