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General NPI Number Information
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NPI Number | 1407303589
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Entity Type | Individual
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Provider Name | JENNIFER WILSON RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 10/14/2017
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Provider Practice Location Address
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Address Line | 7060 WAYSIDE DR
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City | MENTOR
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State | OH
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Zip | 44060-6527
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Country | US
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Telephone | 440-357-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 7060 WAYSIDE DR
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City | MENTOR
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State | OH
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Zip | 44060-6527
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Country | US
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Telephone | 440-357-2700
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN306659
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.020470
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F0117825
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 020470
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License Number State | OH
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