Individual
ETHEL A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, MS, LDN
Contact information
Practice address
11110 MEDICAL CAMPUS RD, SUITE 108, HAGERSTOWN, MD 21742-6700
(301) 714-4041
(301) 714-4351
Mailing address
11110 MEDICAL CAMPUS RD, SUITE 108, HAGERSTOWN, MD 21742-6700
(301) 714-4041
(301) 714-4351
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
D01601
MD
133V00000X
Registered Dietitian
D01601
MD
Other
Enumeration date
10/28/2008
Last updated
11/17/2009
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