Healthcare Provider Details

I. General information

NPI: 1104368679
Provider Name (Legal Business Name): GINA WILBERGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 01/25/2022
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOSPITAL DR SUITE 350
ATHENS OH
45701-2857
US

IV. Provider business mailing address

5450 FRANTZ RD STE 360
DUBLIN OH
43016-4141
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-4491
  • Fax: 740-592-4844
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number322127
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: