Individual
MR. ADAM ABDUL ALIM WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 524-8130
(574) 524-8138
Mailing address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 524-8130
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN. 325391
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
14336 NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0083386
—
OH
01
—
RN.325391
RN NURSING LICENS
OH
Enumeration date
05/04/2006
Last updated
01/17/2024
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