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NPI Code Detail

MEDICARE: MRS. JENNIFER MARIE WILSON MD

MEDICARE: MRS. JENNIFER MARIE WILSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician4301100484MI
2207V00000XObstetrics & Gynecology PhysicianDR.0056560CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154686657
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER MARIE WILSON MD
Provider Business Mailing Address
First Line : 4900 S MONACO ST STE 210
Second Line :
City : DENVER
State : CO
Zip : 80237-3487
Country : US
Telephone Number : 303-788-8808
Fax Number : 303-788-6653
Provider Business Practice Location Address
First Line : 4567 E 9TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80220-3941
Country : US
Telephone Number : 303-320-2455
Fax Number : 303-320-7189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2012
Last Update Date : 02/19/2019

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