Healthcare Provider Details

I. General information

NPI: 1669709861
Provider Name (Legal Business Name): LESLEY DAWN WILSON APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

5107 HICKORY DR
LYNDHURST OH
44124-1046
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-3999
  • Fax:
Mailing address:
  • Phone: 216-970-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0042129
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: