Individual
JESSICA LAUREN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1925 BRADY AVE, ARBUTUS, MD 21227-4109
(302) 363-5363
Mailing address
1925 BRADY AVE, ARBUTUS, MD 21227-4109
(302) 363-5363
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NOT APPLICABLE
—
Enumeration date
09/16/2020
Last updated
09/16/2020
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