Healthcare Provider Details

I. General information

NPI: 1518393040
Provider Name (Legal Business Name): TIFFANY MARIE WILSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MCCORD RD # P-172
TOLEDO OH
43615-8702
US

IV. Provider business mailing address

1800 N MCCORD RD # P-172
TOLEDO OH
43615-8702
US

V. Phone/Fax

Practice location:
  • Phone: 419-514-9452
  • Fax:
Mailing address:
  • Phone: 419-514-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number529690
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number529690
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number529690
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number529690
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number529690
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number529690
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number529690
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: