Individual
JEFFERY C WILT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6501 N 19TH AVE, PHOENIX, AZ 85015-1646
(602) 795-6020
Mailing address
PO BOX 1792, COLUMBIA, SC 29202-1792
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
300934
AZ
367500000X
Certified Registered Nurse Anesthetist
R76080
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1307
—
SC
Enumeration date
05/13/2006
Last updated
03/08/2024
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