Individual
MRS. BARBARA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
6151 CEDAR AVE, PENNSAUKEN, NJ 08109-2317
(707) 484-0181
Mailing address
6151 CEDAR AVE, PENNSAUKEN, NJ 08109-2317
(707) 484-0181
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN005029
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3889264000
AMERIHEALTH
NJ
01
—
54704
INDEPENDENCE BLUE CROSS
NJ
Enumeration date
10/19/2006
Last updated
06/02/2015
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