Provider Demographics
NPI:1255625943
Name:WILMETH, MARGARET GRACE (RN, CNM)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:GRACE
Last Name:WILMETH
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:WILMETH
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:633 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-1906
Mailing Address - Country:US
Mailing Address - Phone:740-380-1828
Mailing Address - Fax:
Practice Address - Street 1:633 WALNUT DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-1906
Practice Address - Country:US
Practice Address - Phone:740-380-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN135886163W00000X
OHCOA02247NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785584Medicaid