Provider Demographics
NPI:1669298212
Name:WILSON, AMBER N (BSN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:WILSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 BLACKLICK RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9533
Mailing Address - Country:US
Mailing Address - Phone:614-747-5550
Mailing Address - Fax:
Practice Address - Street 1:7655 BLACKLICK RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9533
Practice Address - Country:US
Practice Address - Phone:614-747-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH446037163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse