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General NPI Number Information
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NPI Number | 1114188240
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Entity Type | Individual
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Provider Name | JENNIFER S WILNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 785 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1673
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Country | US
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Telephone | 860-523-4100
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Fax | 860-523-1462
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Provider Business Mailing Address
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Address Line | 785 FARMINGTON AVE
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1673
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Country | US
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Telephone | 860-523-4100
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Fax | 860-523-1462
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 248854
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 54316
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 054316
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License Number State | CT
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