Provider Demographics
NPI:1255531703
Name:WILSON, SHERI MELAINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:MELAINE
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FALLSBURG RD NE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9672
Mailing Address - Country:US
Mailing Address - Phone:740-349-1768
Mailing Address - Fax:740-349-1768
Practice Address - Street 1:3501 FALLSBURG RD NE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9672
Practice Address - Country:US
Practice Address - Phone:740-349-1768
Practice Address - Fax:740-349-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.115791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse