MEDICARE: MS. TIFFANY MARIE 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	163WF0300X	Flight Registered Nurse	529690	OH
2	163W00000X	Registered Nurse	529690	OH
3	163WG0000X	General Practice Registered Nurse	529690	OH
4	163WM0102X	Maternal Newborn Registered Nurse	529690	OH
5	163WI0500X	Infusion Therapy Registered Nurse	529690	OH
6	163WP0200X	Pediatric Registered Nurse	529690	OH
7	163WH0200X	Home Health Registered Nurse	529690	OH

General Provider Information

NPI Number	:	1518393040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY MARIE WILSON LPN

Provider Business Mailing Address
First Line	:	1800 N MCCORD RD # P-172
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-8702
Country	:	US
Telephone Number	:	419-514-9452
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N MCCORD RD # P-172
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-8702
Country	:	US
Telephone Number	:	419-514-9452
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	05/24/2024

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