Individual
MIRIAM C WILPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
601 COLLIERS WAY, WEIRTON, WV 26062-5014
(304) 797-6543
Mailing address
109 MOUNT WOOD RD, WHEELING, WV 26003-2632
(304) 233-2455
(304) 233-6073
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54904
WV
367500000X
Certified Registered Nurse Anesthetist
RN220746L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706470
MSBCBS
WV
01
—
001718477
MSBCBS
WV
01
—
001964246
MSBCBS
WV
05
—
0069251000
—
WV
05
—
0207026000
—
WV
05
—
101465372
—
PA
01
—
1062424
WV WORKERS' COMP
WV
01
—
27005299700
WORKERS COMP
WV
01
—
270052997004
TRICARE
WV
01
—
27005299701
BRICKSTREET
WV
01
—
DA0096
RR MEDICARE
WV
Enumeration date
03/08/2006
Last updated
10/29/2013
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