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NPI Code Detail

MEDICARE: MS. BARBARA J WILSON LPN

MEDICARE: MS. BARBARA J 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
1164W00000XLicensed Practical Nurse136567-M-IVOH

General Provider Information

NPI Number : 1447565312
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BARBARA J WILSON LPN
Provider Business Mailing Address
First Line : 5035 LONGMORE CT
Second Line :
City : DAYTON
State : OH
Zip : 45424-5954
Country : US
Telephone Number : 937-418-5613
Fax Number :
Provider Business Practice Location Address
First Line : 5035 LONGMORE CT
Second Line :
City : DAYTON
State : OH
Zip : 45424-5954
Country : US
Telephone Number : 937-418-5613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2010
Last Update Date : 08/16/2010

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