Healthcare Provider Details

I. General information

NPI: 1871708263
Provider Name (Legal Business Name): KATIE MAUD WILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MIAMI VALLEY HOSPITAL ONE WYOMING ST
DAYTON OH
45409
US

IV. Provider business mailing address

1631 PARKHILL DR
DAYTON OH
45406-4139
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6671
  • Fax:
Mailing address:
  • Phone: 937-277-3554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberNS-02119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: