Individual
JORDAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1870 LEONARD ST NE, GRAND RAPIDS, MI 49505
(616) 956-9619
(616) 956-8033
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010388
MI
Other
Enumeration date
06/16/2021
Last updated
11/15/2024
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