Provider Demographics
NPI:1750260436
Name:WILSON, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BUILDING 550
Mailing Address - Street 2:
Mailing Address - City:SPANGDAHLEM
Mailing Address - State:RHINELAND-PALATINATE
Mailing Address - Zip Code:54529
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 550
Practice Address - Street 2:
Practice Address - City:SPANGDAHLEM
Practice Address - State:RHINELAND-PALATINATE
Practice Address - Zip Code:54529
Practice Address - Country:DE
Practice Address - Phone:314-452-8124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020019461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse