Healthcare Provider Details

I. General information

NPI: 1356150494
Provider Name (Legal Business Name): GIA NICOLE WILSON APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 NILES CORTLAND RD
NILES OH
44446-3513
US

IV. Provider business mailing address

421 S HIGH ST
CORTLAND OH
44410-1437
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-2601
  • Fax:
Mailing address:
  • Phone: 330-883-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038385
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.390028
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: