Provider Demographics
NPI:1629852876
Name:WILSON, ZINGA KAFIA
Entity Type:Individual
Prefix:
First Name:ZINGA
Middle Name:KAFIA
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 1:30890 MILES RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1243
Mailing Address - Country:US
Mailing Address - Phone:216-804-4240
Mailing Address - Fax:
Practice Address - Street 1:30890 MILES RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1243
Practice Address - Country:US
Practice Address - Phone:216-804-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.181353.MEDS-IV164W00000X
211D00000X, 171W00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
No172A00000XOther Service ProvidersDriver