Individual
JUSTIN T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8051 PROSPERITY WAY STE 100, RUTHER GLEN, VA 22546-5812
(804) 448-0198
Mailing address
10209 INDIANTOWN RD, KING GEORGE, VA 22485-3539
(540) 421-6688
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0024193809
VA
363LF0000X
Family Nurse Practitioner
Primary
0024193809
VA
Other
Enumeration date
02/06/2024
Last updated
06/19/2025
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