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General NPI Number Information
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NPI Number | 1245291251
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Entity Type | Individual
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Provider Name | JODI ANDERSON WILSON NP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 173 MIDDLE ST
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City | LANCASTER
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State | NH
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Zip | 03584-3508
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Country | US
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Telephone | 603-788-4911
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Fax | 603-326-5831
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Provider Business Mailing Address
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Address Line | 59 PAGE HILL RD
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City | BERLIN
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State | NH
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Zip | 03570-3531
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Country | US
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Telephone | 603-788-5764
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Fax | 603-326-5831
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 180210
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN180210
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License Number State | MA
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