Wilson, Jerry
Wilson, Jerry is an individual health care provider with primary practice located at Hwy 491 N. Pinon St. Red Modular Bldg, Shiprock NM 87420-1830. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Wilson, Jerry can be contacted via phone (505) 368-1050.Contact Information
Primary practice address
Hwy 491 N. Pinon St. Red Modular Bldg
Shiprock NM 87420-1830
Phone: (505) 368-1050
Fax: (505) 368-1055
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 0122591 | New Mexico |
Profile Details
| NPI number | 1962731786 |
|---|---|
| LBN Legal business name | Wilson, Jerry |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 8th, 2009 |
| Last updated | Dec 8th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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