Individual
MISS JESSICA MARIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6011
Mailing address
25476 187TH ST, LEAVENWORTH, KS 66048-8333
(913) 727-1989
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2337807122
KS
Other
Enumeration date
10/27/2010
Last updated
10/27/2010
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