=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225985609
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE LYNN WILSON REGISTERED NURSE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2026
-----------------------------------------------------
Last Update Date | 03/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1852 SINCLAIR AVE
-----------------------------------------------------
City | STEUBENVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43953-3328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-670-9207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 528 BROOKLINE DR
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-670-9207
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 78279
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------