Individual
DR. JESSICA ANN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
155 MAIN ST, BREWSTER, NY 10509-1521
(845) 279-6999
Mailing address
155 MAIN ST, BREWSTER, NY 10509-1521
(845) 279-6999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
300770
NY
207Q00000X
Family Medicine Physician
62647
MN
207Q00000X
Family Medicine Physician
64627
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2016
Last updated
09/03/2019
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