MEDICARE: GLORIA RENEE WILSON STNA

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	400211150203	OH

General Provider Information

NPI Number	:	1215060405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA RENEE WILSON STNA

Provider Business Mailing Address
First Line	:	4359 NORTHFIELD RD
Second Line	:	APT.201A
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-4676
Country	:	US
Telephone Number	:	216-799-1095
Fax Number	:

Provider Business Practice Location Address
First Line	:	4359 NORTHFIELD RD
Second Line	:	APT.201A
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-4676
Country	:	US
Telephone Number	:	216-799-1095
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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