Provider Demographics
NPI:1851782627
Name:WILSON, LYNNE ELLEN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:ELLEN
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 1:2300 WALES AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-2323
Mailing Address - Country:US
Mailing Address - Phone:330-832-3188
Mailing Address - Fax:330-832-9936
Practice Address - Street 1:2300 WALES AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-2323
Practice Address - Country:US
Practice Address - Phone:330-832-3188
Practice Address - Fax:330-832-9936
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16772-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care