Provider Demographics
NPI:1902263866
Name:WILSON, JENNIFER ALMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ALMA
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 PARK NICOLLET BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3400
Practice Address - Fax:952-993-3286
Is Sole Proprietor?:No
Enumeration Date:2016-01-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR 200885-1163W00000X
MNCNP 4189363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse