Individual
DR. JONATHAN B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
620 N DIERS AVE STE 100, GRAND ISLAND, NE 68803-4985
(308) 381-0404
Mailing address
PO BOX 5020, GRAND ISLAND, NE 68802-5020
(308) 381-0404
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
334
NE
Other
Enumeration date
05/31/2012
Last updated
07/18/2012
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