Individual
KIM DITTIS WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
900 E MICHIGAN AVE STE 105, JACKSON, MI 49201-2490
(517) 782-3190
(517) 782-1223
Mailing address
900 E MICHIGAN AVE, STE 105, JACKSON, MI 49201-2490
(517) 782-3190
(517) 782-1223
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704131316
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500017755
RR MEIDCARE
MI
Enumeration date
06/07/2006
Last updated
03/17/2018
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