Provider Demographics
NPI:1699533364
Name:WILSON, MIKESHA MONEA
Entity type:Individual
Prefix:
First Name:MIKESHA
Middle Name:MONEA
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 1:1104 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3630
Mailing Address - Country:US
Mailing Address - Phone:216-904-9958
Mailing Address - Fax:
Practice Address - Street 1:1104 BRANDON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44112-3630
Practice Address - Country:US
Practice Address - Phone:216-904-9958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker