Provider Demographics
NPI:1053036483
Name:WILSON, SHARIA L (EMT-B)
Entity type:Individual
Prefix:MISS
First Name:SHARIA
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1968
Mailing Address - Country:US
Mailing Address - Phone:614-348-6518
Mailing Address - Fax:
Practice Address - Street 1:502 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1968
Practice Address - Country:US
Practice Address - Phone:614-348-6518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH0179802146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No374U00000XNursing Service Related ProvidersHome Health Aide