MEDICARE: LASHONDA 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
1	163WM0705X	Medical-Surgical Registered Nurse	448636	OH

General Provider Information

NPI Number	:	1235080888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHONDA WILSON RN

Provider Business Mailing Address
First Line	:	5335 SOUTH BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2753
Country	:	US
Telephone Number	:	216-276-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5335 SOUTH BLVD
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2753
Country	:	US
Telephone Number	:	216-276-5992
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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