Provider Demographics
NPI:1861118127
Name:BEASLEY, WILSON CHESTER III
Entity type:Individual
Prefix:MR
First Name:WILSON
Middle Name:CHESTER
Last Name:BEASLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LIME CITY RD APT 8
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1419
Mailing Address - Country:US
Mailing Address - Phone:419-320-2310
Mailing Address - Fax:
Practice Address - Street 1:525 LIME CITY RD APT 8
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1419
Practice Address - Country:US
Practice Address - Phone:419-320-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant