Provider Demographics
NPI:1750020608
Name:WILSON, NASTASSIA A
Entity Type:Individual
Prefix:
First Name:NASTASSIA
Middle Name:A
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 1:25300 ROCKSIDE RD # B722
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1940
Mailing Address - Country:US
Mailing Address - Phone:216-334-0205
Mailing Address - Fax:
Practice Address - Street 1:11821 PARKHILL AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-3025
Practice Address - Country:US
Practice Address - Phone:216-334-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide