Individual
MS. JENNIFER BRYANT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
600 HIGHLAND AVE, MADISON, WI 53792-0001
(608) 263-7502
(608) 263-7652
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2902-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6825422
—
SD
Enumeration date
05/11/2006
Last updated
04/30/2015
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