MEDICARE: GAIL A WILSON RN

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	163W00000X	Registered Nurse	364261	OH

General Provider Information

NPI Number	:	1639574643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL A WILSON RN

Provider Business Mailing Address
First Line	:	1205 31ST ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-1525
Country	:	US
Telephone Number	:	330-412-2073
Fax Number	:	330-546-0866

Provider Business Practice Location Address
First Line	:	1205 31ST ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44714-1525
Country	:	US
Telephone Number	:	330-412-2073
Fax Number	:	330-546-0866

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

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	11/03/2014

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Directions to “ GAIL A WILSON RN” Practice Location

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