Provider Demographics
NPI:1942533229
Name:WILSON, REBECCA FAY (RN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:FAY
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 SPRING ST APT S8
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-2292
Mailing Address - Country:US
Mailing Address - Phone:440-812-9224
Mailing Address - Fax:
Practice Address - Street 1:855 SPRING ST APT S8
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2292
Practice Address - Country:US
Practice Address - Phone:440-812-9224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN291288163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse