Individual
ROBERT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN-CNP
Contact information
Practice address
929 NW 164TH ST, EDMOND, OK 73013-1002
(469) 337-3720
Mailing address
929 NW 164TH ST, EDMOND, OK 73013-1002
(469) 337-3720
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
100293
OK
163W00000X
Registered Nurse
775271
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100293
CNP LICENSE
OK
Enumeration date
10/05/2014
Last updated
07/26/2015
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