Individual
JENNIFER MICHELE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
20606 N INTERSTATE 35, WEST, TX 76691-1812
(254) 405-3313
Mailing address
163 FM 2114, AQUILLA, TX 76622-2412
(512) 202-5342
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
210280
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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