Individual
JENNIFER E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9800 BROADWAY EXT, OKLAHOMA CITY, OK 73114-6303
(405) 419-2980
Mailing address
1500 NW 192ND TER, EDMOND, OK 73012-9123
(620) 200-3398
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0096394
OK
163W00000X
Registered Nurse
114757041
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
96394
OK
Other
Enumeration date
06/24/2014
Last updated
10/11/2017
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