Individual
DONOVAN DEAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 844-1121
Mailing address
350 BLOUNTVILLE HWY, STE 207, BRISTOL, TN 37620-0213
(423) 968-4540
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
112090
TX
367500000X
Certified Registered Nurse Anesthetist
37086
TN
Other
Enumeration date
06/29/2006
Last updated
05/20/2019
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