MEDICARE: MRS. APRIL LATRICE WILSON LPN

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	164W00000X	Licensed Practical Nurse	LPN.156299.MEDS-IV	OH

General Provider Information

NPI Number	:	1245724012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. APRIL LATRICE WILSON LPN

Provider Business Mailing Address
First Line	:	1757 INDIAN WOOD CIR
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-4009
Country	:	US
Telephone Number	:	866-203-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 BERWICK AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1516
Country	:	US
Telephone Number	:	567-315-5025
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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