Provider Demographics
NPI:1306037965
Name:WILSON, JANE MARIE (RN,RD,CDE,CSR)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN,RD,CDE,CSR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2512
Mailing Address - Country:US
Mailing Address - Phone:804-282-3207
Mailing Address - Fax:
Practice Address - Street 1:8001 FRANKLIN FARMS DR
Practice Address - Street 2:SUITE 215
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-5108
Practice Address - Country:US
Practice Address - Phone:804-263-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 133VN1005X, 133VN1006X
VA0001088548163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator