Individual
JANET DIANE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1315 HOSPITAL DRIVE, ST JOHNSBURY, VT 05819-0905
(802) 748-8141
(802) 748-4098
Mailing address
PO BOX 905, ST JOHNSBURY, VT 05819-0905
(802) 748-8141
(802) 748-4098
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
12631
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1511739
MEDICAID MCC TEMP#
TN
Enumeration date
04/06/2007
Last updated
08/31/2009
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