Healthcare Provider Details

I. General information

NPI: 1336083856
Provider Name (Legal Business Name): RAMONDA WILLETT WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5621 BENEDICT RD
DAYTON OH
45424-4211
US

IV. Provider business mailing address

5621 BENEDICT RD
DAYTON OH
45424-4211
US

V. Phone/Fax

Practice location:
  • Phone: 937-204-6972
  • Fax:
Mailing address:
  • Phone: 937-204-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400545161006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: