Provider Demographics
NPI:1497117162
Name:WILSON, JENNIFER LYNN (APRN-RX, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN-RX, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1872
Mailing Address - Country:US
Mailing Address - Phone:808-206-5301
Mailing Address - Fax:808-200-3785
Practice Address - Street 1:1401 S BERETANIA ST STE 400
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1872
Practice Address - Country:US
Practice Address - Phone:808-206-5301
Practice Address - Fax:808-200-3785
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily