Individual
DEBORAH WILMOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2 SAINT VINCENT CIR, LITTLE ROCK, AR 72205-5423
(501) 664-4532
(501) 663-4335
Mailing address
500 S UNIVERSITY AVE STE 500, LITTLE ROCK, AR 72205-5307
(501) 664-4532
(501) 663-4335
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R019451
AR
367500000X
Certified Registered Nurse Anesthetist
Primary
C000459
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157533001
—
AR
01
—
59536
BLUE CROSS BLUE SHIELD
AR
Enumeration date
09/27/2005
Last updated
04/15/2020
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