MEDICARE: MRS. JULIA WILSON CNP MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN.CNP.07935	OH
2	363LW0102X	Women's Health Nurse Practitioner	APRN.CNP.07935	OH

General Provider Information

NPI Number	:	1023020591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA WILSON CNP MSN

Provider Business Mailing Address
First Line	:	5450 FRANTZ RD STE 360
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43016-4141
Country	:	US
Telephone Number	:	614-544-6155
Fax Number	:	614-544-6370

Provider Business Practice Location Address
First Line	:	4191 KELNOR DR STE 200
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-3990
Country	:	US
Telephone Number	:	614-533-6140
Fax Number	:	614-533-6141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	01/25/2022

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