Provider Demographics
NPI:1457818288
Name:WILHELM, JEFFERIE MICHAEL (NP-C)
Entity Type:Individual
Prefix:
First Name:JEFFERIE
Middle Name:MICHAEL
Last Name:WILHELM
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 LINCOLN WAY NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-5203
Mailing Address - Country:US
Mailing Address - Phone:330-236-2285
Mailing Address - Fax:
Practice Address - Street 1:2935 LINCOLN WAY NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5203
Practice Address - Country:US
Practice Address - Phone:330-236-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024356363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care