MEDICARE: CHAKEBA T WILSON

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	376K00000X	Nurse's Aide	400093340302	OH

General Provider Information

NPI Number	:	1083571541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAKEBA T WILSON

Provider Business Mailing Address
First Line	:	1130 DALLAS RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3325
Country	:	US
Telephone Number	:	216-288-3567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 DALLAS RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3325
Country	:	US
Telephone Number	:	216-288-3567
Fax Number	:

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

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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Directions to “ CHAKEBA T WILSON ” Practice Location

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