MEDICARE: MISS SHARIA L WILSON EMT-B

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	374U00000X	Home Health Aide
2	146N00000X	Basic Emergency Medical Technician	0179802	OH

General Provider Information

NPI Number	:	1053036483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHARIA L WILSON EMT-B

Provider Business Mailing Address
First Line	:	502 CATHERINE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1968
Country	:	US
Telephone Number	:	614-348-6518
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 CATHERINE ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-1968
Country	:	US
Telephone Number	:	614-348-6518
Fax Number	:

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

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	10/07/2022

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