Individual
JESSICA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 W BROADWAY UNIT 2, HEWLETT, NY 11557-1913
(209) 405-0455
Mailing address
3215 53RD PL, WOODSIDE, NY 11377-1925
(209) 405-0455
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
04/30/2019
Last updated
12/07/2020
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