Provider Demographics
NPI:1043553209
Name:WILSON, TOCCARA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:TOCCARA
Middle Name:NICOLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26281 MALLARD AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1411
Mailing Address - Country:US
Mailing Address - Phone:216-392-1057
Mailing Address - Fax:
Practice Address - Street 1:26281 MALLARD AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1411
Practice Address - Country:US
Practice Address - Phone:216-392-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH149737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse