Individual
MALLORY A WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1201 11TH AVE S, BIRMINGHAM, AL 35205-3410
(205) 930-7296
(205) 930-7256
Mailing address
PO BOX 55905, BIRMINGHAM, AL 35255-5905
(205) 930-7296
(205) 930-7256
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-100306
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114195476
—
AL
01
—
51547667
BC BS OF AL
AL
Enumeration date
02/20/2008
Last updated
06/04/2008
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