Provider Demographics
NPI:1710520788
Name:WILSON, PATIENCE DAWN (CNP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:DAWN
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3224
Mailing Address - Country:US
Mailing Address - Phone:330-401-5628
Mailing Address - Fax:
Practice Address - Street 1:4465 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1884
Practice Address - Country:US
Practice Address - Phone:330-688-9918
Practice Address - Fax:330-688-4718
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024627363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology