| NPI | 1407399090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN M WILSON Project Manager Billing 740-258-6480 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019584) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2016-11-30 |