Healthcare Provider Details

I. General information

NPI: 1801087473
Provider Name (Legal Business Name): JANE WILSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FRANKLIN FARMS DR SUITE 215
RICHMOND VA
23229-5108
US

IV. Provider business mailing address

6226 W FRANKLIN ST
RICHMOND VA
23226-2512
US

V. Phone/Fax

Practice location:
  • Phone: 804-263-6010
  • Fax:
Mailing address:
  • Phone: 804-282-3207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001088548
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0001088548
License Number StateVA

VIII. Authorized Official

Name: MRS. JANE MARIE WILSON
Title or Position: GENERAL MANAGER/BUSINESS OWNER
Credential: RN,RD,CDE,CSR
Phone: 804-282-3207