Individual
MS. JENNIFER MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1700 GEARY ST SE, ALBANY, OR 97322-6842
(541) 812-5500
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201250109NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500656964
—
OR
Enumeration date
01/18/2012
Last updated
11/03/2020
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