Healthcare Provider Details

I. General information

NPI: 1285023044
Provider Name (Legal Business Name): CHRISTINA MARIE WILSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE QUALE

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CEI DR
BLUE ASH OH
45242-5664
US

IV. Provider business mailing address

1945 CEI DR
BLUE ASH OH
45242-5664
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5133
  • Fax: 513-984-4240
Mailing address:
  • Phone: 513-984-5133
  • Fax: 513-984-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN.372673
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: