Provider Demographics
NPI:1891501169
Name:WILSON, MICHELE MARLENE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARLENE
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 1:1647 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4424
Mailing Address - Country:US
Mailing Address - Phone:740-352-2306
Mailing Address - Fax:
Practice Address - Street 1:3900 RHODES AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4974
Practice Address - Country:US
Practice Address - Phone:740-464-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker