Provider Demographics
NPI:1841691342
Name:WILSON, JENNIFER TOMIKO (LVN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TOMIKO
Last Name:WILSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:TOMIKO
Other - Last Name:GUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:1919 APPLE ST STE F&G
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4492
Mailing Address - Country:US
Mailing Address - Phone:760-547-1280
Mailing Address - Fax:760-547-1268
Practice Address - Street 1:1919 APPLE ST STE F&G
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4492
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:760-547-1268
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN275092164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4000OtherJENNIFER