Individual
TEREASA KELLEY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
700 E UNIVERSITY AVE, DES MOINES, IA 50316-2302
(515) 991-6935
Mailing address
16901 LAKESIDE HILLS CT, OMAHA, NE 68130-2318
(515) 991-6935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
119753
IA
367500000X
Certified Registered Nurse Anesthetist
Primary
101283
NE
367500000X
Certified Registered Nurse Anesthetist
D119753
IA
Other
Enumeration date
05/14/2014
Last updated
08/03/2022
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