Provider Demographics
NPI:1508520867
Name:WILSON, MARTIN R (AM)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:AM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3237
Mailing Address - Country:US
Mailing Address - Phone:194-308-1791
Mailing Address - Fax:
Practice Address - Street 1:202 BIDDLE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3237
Practice Address - Country:US
Practice Address - Phone:194-308-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide