MEDICARE: DR. JEAN ELLEN WILSON D.O.

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	207Q00000X	Family Medicine Physician	OS 012551	PA
2	207Q00000X	Family Medicine Physician	34011096	OH

General Provider Information

NPI Number	:	1700866266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN ELLEN WILSON D.O.

Provider Business Mailing Address
First Line	:	1034 GROVE ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-2945
Country	:	US
Telephone Number	:	814-333-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 W LIBERTY ST
Second Line	:
City	:	HUBBARD
State	:	OH
Zip	:	44425-1753
Country	:	US
Telephone Number	:	330-269-1934
Fax Number	:	330-568-4267

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/05/2026

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