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NPI Code Detail

MEDICARE: GLORIA J WILSON CNP

MEDICARE: GLORIA J WILSON CNP
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
1363LF0000XFamily Nurse PractitionerCOA12816NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437420452
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA J WILSON CNP
Provider Business Mailing Address
First Line : 5964 GOLF CLUB LN
Second Line :
City : FAIRFIELD TOWNSHIP
State : OH
Zip : 45011-8224
Country : US
Telephone Number : 513-893-1100
Fax Number : 513-893-1128
Provider Business Practice Location Address
First Line : 5964 GOLF CLUB LN
Second Line :
City : FAIRFIELD TOWNSHIP
State : OH
Zip : 45011-8224
Country : US
Telephone Number : 513-893-1100
Fax Number : 513-893-1128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2012
Last Update Date : 11/13/2020

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