Individual
TIMOTHY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 E 28TH ST, MINNEAPOLIS, MN 55407-3723
(612) 863-4000
Mailing address
4401 PARK GLEN RD APT 306, ST LOUIS PARK, MN 55416-4768
(707) 315-7142
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 215550-0
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
111898
MN
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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