Provider Demographics
NPI:1467153205
Name:WILSON, DANIEL TODD (APRN)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:TODD
Last Name:WILSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8899 CYPRESSGATE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6414
Mailing Address - Country:US
Mailing Address - Phone:937-416-9969
Mailing Address - Fax:
Practice Address - Street 1:8899 CYPRESSGATE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-6414
Practice Address - Country:US
Practice Address - Phone:937-416-9969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032862363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health