Provider Demographics
NPI:1760857098
Name:WILSON, ALICIA N (CNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:N
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:225 W MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-2411
Mailing Address - Fax:937-393-3711
Practice Address - Street 1:225 W MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-2411
Practice Address - Fax:937-393-3711
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18513-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0153633Medicaid