Individual
MARK S WILKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
250 NE MULBERRY ST, C/O SJS MEDICAL MANAGEMENT, SUITE 202, LEES SUMMIT, MO 64086-4533
(816) 389-4130
(816) 389-4140
Mailing address
804 COTTONWOOD PL, LIBERTY, MO 64068-9203
(816) 407-7204
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
095684
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
913767018
—
MO
Enumeration date
03/24/2006
Last updated
06/02/2008
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