Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024181726 | VA |
N | 363LC1500X | Nurse Practitioner - Community Health | 0024181726 | VA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 0024181726 | VA |
NPI | 1639845118 |
---|---|
Provider Name | Jennifer L Willson |
First Address | Woodbridge, VA 22192-7667 |
Second Address | Woodbridge, VA 22192-7667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 20/09/2021 |