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Individual

JEANINE M WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4549 SPOTSWOOD TRL STE 8, PENN LAIRD, VA 22846-2050
(540) 433-8700
(540) 433-8080
Mailing address
4549 SPOTSWOOD TRL STE 8, PENN LAIRD, VA 22846-2050
(540) 433-8700
(540) 433-8080

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002529
VA
363AM0700X
Medical Physician Assistant
Primary
0110002529
VA

Other

Enumeration date
08/06/2007
Last updated
10/02/2022
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