Individual
STACI ERICA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1602 SKIPWITH RD, RICHMOND, VA 23229-5205
(804) 289-4500
Mailing address
2005 AIRY CIR, HENRICO, VA 23238-3274
(214) 354-6170
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
0001243128
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0001243128
VA
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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