Individual
MRS. REBECCA LEE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301
(304) 388-6261
(304) 388-3604
Mailing address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 932-4166
(304) 388-3604
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN27016-CRNA
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065260000
—
WV
01
—
4430069474
CAMC RAILROAD MEDICARE
WV
Enumeration date
10/27/2006
Last updated
05/03/2017
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