Individual
ETHAN VINCENT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RDN
Contact information
Practice address
3801 SPRING ST, MOUNT PLEASANT, WI 53405-1667
(262) 687-4011
Mailing address
3301 13TH ST # 6D, KENOSHA, WI 53144-2931
(563) 271-6515
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.011343
IL
133V00000X
Registered Dietitian
2023034183
MO
133V00000X
Registered Dietitian
5820-29
WI
Other
Enumeration date
06/24/2024
Last updated
03/17/2026
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