Jessica Wilson

NPI #1164086617 in Hewlett, New York

Provider Information

NPI Number: 1164086617
Entity Type: Individual
Name: Jessica Wilson
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dietitian, Registered
Enumeration Date: Apr 30, 2019
Last Updated: Dec 7, 2020

Practice Location

Address: 1200 W BROADWAY UNIT 2
City: Hewlett
State: New York
ZIP Code: 11557-1913
Phone: (209) 405-0455

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietitian, Registered	133V00000X	Primary

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