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NPI Code Detail

MEDICARE: JENNIFER ANN WILSON MD

MEDICARE: JENNIFER ANN 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
1207Q00000XFamily Medicine PhysicianA86620CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100A691360OTHERCAPPIN

General Provider Information

NPI Number : 1558378984
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN WILSON MD
Provider Business Mailing Address
First Line : 1141 PEAR TREE LN STE 100
Second Line :
City : NAPA
State : CA
Zip : 94558-6485
Country : US
Telephone Number : 707-254-1770
Fax Number : 707-254-1779
Provider Business Practice Location Address
First Line : 300 HARTLE CT
Second Line :
City : NAPA
State : CA
Zip : 94559-4078
Country : US
Telephone Number : 707-254-1775
Fax Number : 707-251-1779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 02/27/2020

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