Individual
MRS. JOYCELYN AMPON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 SMITH AVE N, SAINT PAUL, MN 55102-2344
(651) 241-8000
Mailing address
4401 PARK GLEN RD APT 301, MINNEAPOLIS, MN 55416-4767
(808) 352-7728
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2208091
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122707
NBCRNA CREDENTIAL ID
—
01
—
2208091
MINNESOTA RN LICENSE NUMBER
MN
Enumeration date
04/01/2019
Last updated
04/01/2019
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