Provider Demographics
NPI:1386443455
Name:WILSON, CAMERON ALEXIS
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:ALEXIS
Last Name:WILSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-4598
Mailing Address - Country:US
Mailing Address - Phone:330-819-6922
Mailing Address - Fax:
Practice Address - Street 1:3975 EMBASSY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-8335
Practice Address - Country:US
Practice Address - Phone:330-668-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH476570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse