MEDICARE: GERRELL WILSON

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1720782881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERRELL WILSON

Provider Business Mailing Address
First Line	:	10220 POTTINGER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1116
Country	:	US
Telephone Number	:	513-372-4756
Fax Number	:

Provider Business Practice Location Address
First Line	:	10220 POTTINGER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1116
Country	:	US
Telephone Number	:	513-372-4756
Fax Number	:

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

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	03/30/2023

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Directions to “ GERRELL WILSON ” Practice Location

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