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NPI Code Detail

MEDICARE: VALERIE WILSON RN

MEDICARE: VALERIE WILSON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA0400XAddiction (Substance Use Disorder) Registered NurseRN.222719OH
2163WC0400XCase Management Registered NurseRN.222719OH
3163WC1500XCommunity Health Registered NurseRN.222719OH

General Provider Information

NPI Number : 1174302053
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALERIE WILSON RN
Provider Business Mailing Address
First Line : 6809 MAYFIELD RD APT N1252
Second Line :
City : MAYFIELD HTS
State : OH
Zip : 44124-2273
Country : US
Telephone Number : 216-990-0915
Fax Number :
Provider Business Practice Location Address
First Line : 17325 EUCLID AVE STE 3040
Second Line :
City : CLEVELAND
State : OH
Zip : 44112-1276
Country : US
Telephone Number : 216-273-6888
Fax Number : 216-273-6888
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2023
Last Update Date : 09/28/2023

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