Individual
AMANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
229 N BLOCK AVE, FAYETTEVILLE, AR 72701-5204
(479) 200-2749
Mailing address
3610 N TOWER CIR, FAYETTEVILLE, AR 72704-7402
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
163WN1003X
Nutrition Support Registered Nurse
Primary
R090453
AR
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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