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General NPI Number Information
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NPI Number | 1912029224
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Entity Type | Individual
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Provider Name | JANET DIANE WILSON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 1315 HOSPITAL DRIVE
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-0905
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Country | US
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Telephone | 802-748-8141
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Fax | 802-748-4098
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Provider Business Mailing Address
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Address Line | PO BOX 905
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City | ST JOHNSBURY
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State | VT
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Zip | 05819-0905
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Country | US
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Telephone | 802-748-8141
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Fax | 802-748-4098
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12631
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License Number State | TN
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