NPI 1205197878 · live from the CMS NPI Registry
Jonathan B Wilson, DPM
Podiatrist in Grand Island, NE. National Provider Identifier 1205197878, active.
NPI record
| NPI | 1205197878 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist 213E00000X |
| Practice location | 620 N Diers Ave Ste 100, Grand Island, NE 68803 |
| Practice phone | 308-381-0404 |
| Mailing address | Po Box 5020, Grand Island, NE 68802 |
| Enumerated | May 31, 2012 |
| Last updated | July 18, 2012 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist primary | 213E00000X | 334 (NE) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.