Individual
JENNIFER J WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1801 N. NAVAJO DR., PAGE, AZ 86040
(928) 608-4200
(928) 645-5059
Mailing address
PO BOX 1927, PAGE, AZ 86040-1927
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP046189
AZ
Other
Enumeration date
01/20/2010
Last updated
01/20/2010
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