Individual
MS. JILLIAN M WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1600 CRAIN HWY S STE 401, GLEN BURNIE, MD 21061-6413
(410) 768-5050
Mailing address
7467 RIDGE RD STE 140, HANOVER, MD 21076-3118
(410) 768-5050
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/10/2020
Last updated
04/06/2023
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