MEDICARE: MRS. SUSAN L VILD MSN, RN, FNP C

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.05403	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1801899083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN L VILD MSN, RN, FNP C

Provider Business Mailing Address
First Line	:	2815 DUSTIN RD
Second Line	:	STE C
City	:	OREGON
State	:	OH
Zip	:	43616-3344
Country	:	US
Telephone Number	:	419-691-6781
Fax Number	:	419-691-0082

Provider Business Practice Location Address
First Line	:	2815 DUSTIN RD
Second Line	:	STE C
City	:	OREGON
State	:	OH
Zip	:	43616-3344
Country	:	US
Telephone Number	:	419-691-6781
Fax Number	:	419-691-0082

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/12/2024

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