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General NPI Number Information
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NPI Number | 1245870815
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Entity Type | Individual
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Provider Name | JASON T WILHELM CNP
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 1598 S COUNTY TRL STE 100
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City | EAST GREENWICH
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State | RI
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Zip | 02818-1762
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Country | US
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Telephone | 401-402-1090
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1119
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City | PROVIDENCE
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State | RI
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Zip | 02901-1119
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Country | US
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Telephone |
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Fax |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN02480
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License Number State | RI
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