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General NPI Number Information
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NPI Number | 1942889209
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Entity Type | Individual
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Provider Name | JESSICA LYNN WILSON CNP
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Gender | Female
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 04/05/2021
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Provider Practice Location Address
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Address Line | 10 4TH AVE SE
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City | GLENWOOD
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State | MN
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Zip | 56334-1820
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Country | US
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Telephone | 320-634-4521
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Fax | 320-634-2253
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Provider Business Mailing Address
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Address Line | 10 4TH AVE SE
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City | GLENWOOD
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State | MN
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Zip | 56334-1820
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Country | US
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Telephone | 320-634-4521
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Fax | 320-634-2253
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 8121
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License Number State | MN
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