Provider Demographics
NPI:1548862709
Name:DE WILDE, JOSY ANN
Entity type:Individual
Prefix:
First Name:JOSY
Middle Name:ANN
Last Name:DE WILDE
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 1:3539 CARPER AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3607
Mailing Address - Country:US
Mailing Address - Phone:330-628-4635
Mailing Address - Fax:
Practice Address - Street 1:3539 CARPER AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3607
Practice Address - Country:US
Practice Address - Phone:330-628-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No347E00000XTransportation ServicesTransportation Broker