Individual
JIMMY-JOHN CLIFFORD WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
162260
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
075318
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052804
—
NC
01
—
P00408503
RAILROAD MEDICARE
NC
Enumeration date
01/11/2007
Last updated
07/24/2020
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