Individual
JENNIFER MICHELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1760 E RIVER RD, STE. # 350, TUCSON, AZ 85718-5877
(520) 519-7775
Mailing address
6320 W UNION HILLS DR, STE B - 1600, GLENDALE, AZ 85308-1096
(602) 357-2400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5385
AZ
363AS0400X
Surgical Physician Assistant
PA-091
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
661364
—
AZ
Enumeration date
06/16/2011
Last updated
01/31/2014
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