Healthcare Provider Details

I. General information

NPI: 1548064678
Provider Name (Legal Business Name): JAMIE WOSSILEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUBLIN DR
DOVER OH
44622-7805
US

IV. Provider business mailing address

844 TALLMADGE RD
CUYAHOGA FALLS OH
44221-5067
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-8038
  • Fax: 330-364-4732
Mailing address:
  • Phone: 440-396-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038070
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: