Individual
MS. JENNIFER E WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
335 BRIGHTON AVE, PORTLAND, ME 04102-2362
(207) 662-8321
Mailing address
335 BRIGHTON AVE, PORTLAND, ME 04102-2362
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
292511
ME
Other
Enumeration date
12/15/2006
Last updated
07/08/2007
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