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General NPI Number Information
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NPI Number | 1972353563
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Entity Type | Individual
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Provider Name | LAKEISHA WILSON
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2131 E 4TH ST
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City | DAYTON
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State | OH
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Zip | 45403-2001
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Country | US
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Telephone | 937-825-5012
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 E 4TH ST
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City | DAYTON
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State | OH
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Zip | 45403-2001
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Country | US
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Telephone | 513-295-9626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State | OH
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