Basic Information
| Provider Information | |||||||||
| NPI: | 1952719700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILHELM | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13909 GARFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WAKEMAN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448899514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409654428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 LIVINGSTON AVE BLDG B | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440523781 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402331068 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2014 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 50.001320 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.