Individual
MRS. JENNIFER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
7060 WAYSIDE DR, MENTOR, OH 44060-6527
(440) 357-2700
Mailing address
7060 WAYSIDE DR, MENTOR, OH 44060-6527
(440) 357-2700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN306659
OH
363L00000X
Nurse Practitioner
APRN.CNP.020470
OH
363LF0000X
Family Nurse Practitioner
Primary
020470
OH
363LF0000X
Family Nurse Practitioner
F0117825
OH
Other
Enumeration date
09/06/2016
Last updated
10/14/2017
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