Provider Demographics
NPI:1619754835
Name:WILSON, RHODA G
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:G
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8875 BLUE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BLUE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45616-9048
Mailing Address - Country:US
Mailing Address - Phone:937-779-9807
Mailing Address - Fax:
Practice Address - Street 1:8875 BLUE CREEK RD
Practice Address - Street 2:
Practice Address - City:BLUE CREEK
Practice Address - State:OH
Practice Address - Zip Code:45616-9048
Practice Address - Country:US
Practice Address - Phone:937-779-9807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363724791189163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health