Individual
ALICIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1400 NW 12TH AVE, MIAMI, FL 33136
(302) 243-9878
Mailing address
1400 NW 12TH AVE, MIAMI, FL 33136-1003
(302) 243-9878
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9336578
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
9336578
FL
Other
Enumeration date
10/16/2016
Last updated
03/24/2019
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