Individual
JEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-B.C.
Contact information
Practice address
319 STANLEY AVE, BAYONNE, NJ 07002-5068
(336) 740-0897
(888) 979-8335
Mailing address
319 STANLEY AVE, BAYONNE, NJ 07002-5068
(336) 740-0897
(888) 979-8335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R127999
MD
363L00000X
Nurse Practitioner
26NJ00418200
NJ
363L00000X
Nurse Practitioner
F337917
NY
363L00000X
Nurse Practitioner
R127999
MD
363LF0000X
Family Nurse Practitioner
Primary
5005315
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7005409
—
NC
Enumeration date
07/29/2011
Last updated
02/16/2015
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