Individual
MISS JENNIFER A. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.S.T.
Contact information
Practice address
6500 W EMERALD ST, BOISE, ID 83704-8736
(208) 377-0777
(208) 377-1070
Mailing address
6500 W EMERALD ST, BOISE, ID 83704-8736
(208) 377-0777
(208) 377-1070
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
89338
ID
Other
Enumeration date
01/23/2008
Last updated
01/23/2008
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