Healthcare Provider Details

I. General information

NPI: 1811025059
Provider Name (Legal Business Name): EMILY G WILFORD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/26/2024
Certification Date: 02/15/2022
Deactivation Date: 02/15/2022
Reactivation Date: 08/26/2024

III. Provider practice location address

2663 CLEVELAND AVE NW
CANTON OH
44709-3393
US

IV. Provider business mailing address

2116 9TH ST
CUYAHOGA FALLS OH
44221-3125
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-5329
  • Fax: 330-456-9679
Mailing address:
  • Phone: 330-926-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP-07849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: