Individual
JONATHAN D WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3225 W GORDON AVE STE 1, LAYTON, UT 84041-5728
(801) 397-6150
(801) 397-6151
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3481
(801) 397-6151
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6496499-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
UT
Enumeration date
07/02/2018
Last updated
07/02/2018
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