Healthcare Provider Details

I. General information

NPI: 1518787720
Provider Name (Legal Business Name): JULIENNE ELIZABETH WILSON MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 COVENTRY RD
DAYTON OH
45420-2403
US

IV. Provider business mailing address

1809 COVENTRY RD
DAYTON OH
45420-2403
US

V. Phone/Fax

Practice location:
  • Phone: 317-999-5775
  • Fax:
Mailing address:
  • Phone: 317-999-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: