Individual
MRS. LISA GIBSON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
54 SERGEANT PRENTISS DR, NATCHEZ, MS 39120-4726
(601) 443-2100
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-1428
(601) 936-0682
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R818593
MS
Other
Enumeration date
09/07/2005
Last updated
05/30/2008
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