Individual
XAVIER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2003 W FULTON ST, CHICAGO, IL 60612-2345
(312) 850-3438
Mailing address
832 CHANCELLOR AVE, IRVINGTON, NJ 07111
(973) 399-6292
(973) 372-4534
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814644
ADA
NJ
Enumeration date
04/27/2007
Last updated
07/26/2019
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