MEDICARE: GRETCHEN M 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427634427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN M WILSON

Provider Business Mailing Address
First Line	:	53461 YORK DR
Second Line	:
City	:	POWHATAN PT
State	:	OH
Zip	:	43942-9752
Country	:	US
Telephone Number	:	740-338-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	53461 YORK DR
Second Line	:
City	:	POWHATAN PT
State	:	OH
Zip	:	43942-9752
Country	:	US
Telephone Number	:	740-338-8589
Fax Number	:

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

Provider Enumeration Date	:	03/20/2021
Last Update Date	:	03/20/2021

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Directions to “ GRETCHEN M WILSON ” Practice Location

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