Individual
JEANNETTE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4222 CRYSTAL LAKE TRL, FARIBAULT, MN 55021-7975
(507) 696-1200
Mailing address
4222 CRYSTAL LAKE TRL, FARIBAULT, MN 55021-7975
(507) 696-1200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R-164987-1
MN
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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