Provider Demographics
NPI:1427634427
Name:WILSON, GRETCHEN M
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
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 1:53461 YORK DR
Mailing Address - Street 2:
Mailing Address - City:POWHATAN PT
Mailing Address - State:OH
Mailing Address - Zip Code:43942-9752
Mailing Address - Country:US
Mailing Address - Phone:740-338-8589
Mailing Address - Fax:
Practice Address - Street 1:53461 YORK DR
Practice Address - Street 2:
Practice Address - City:POWHATAN PT
Practice Address - State:OH
Practice Address - Zip Code:43942-9752
Practice Address - Country:US
Practice Address - Phone:740-338-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care