Individual
JILLIAN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,RD
Contact information
Practice address
4800 BEAR RD, LIVERPOOL, NY 13088-4604
(315) 200-2181
Mailing address
4190 HENNEBERRY RD, MANLIUS, NY 13104-9567
(315) 200-2181
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86119687
NY
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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