Individual
MS. JENNIFER RENEE WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
3673 HILLSBOROUGH RD., DURHAM, NC 27705
(866) 389-2727
Mailing address
14 LORELEI CT, DURHAM, NC 27713-4495
(919) 578-4853
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5005791
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000704774
ANTHEM BC/BS
IN
05
—
201013390A
—
IN
Enumeration date
02/09/2011
Last updated
06/16/2014
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