Provider Demographics
NPI:1497563605
Name:WILSON, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 N MORELAND BLVD APT 305
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1370
Mailing Address - Country:US
Mailing Address - Phone:216-773-0078
Mailing Address - Fax:
Practice Address - Street 1:1505 EAST 221ST ST
Practice Address - Street 2:APT 305
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44117-4411
Practice Address - Country:US
Practice Address - Phone:216-336-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator