Provider Demographics
NPI:1861386492
Name:WILSON, ROXANNA
Entity type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
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 1:3887 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HORNER
Mailing Address - State:WV
Mailing Address - Zip Code:26372-9626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3887 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:HORNER
Practice Address - State:WV
Practice Address - Zip Code:26372-9626
Practice Address - Country:US
Practice Address - Phone:681-495-2436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide