Individual
JUSTIN ADAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
680996-1
NY
367500000X
Certified Registered Nurse Anesthetist
Primary
244761
WI
Other
Enumeration date
01/27/2014
Last updated
01/12/2021
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