Individual
DANA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3923
(731) 668-1853
(731) 664-7731
Mailing address
10 CHATWICK CV, JACKSON, TN 38305-5641
(731) 668-1853
(731) 664-7731
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
91906
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
14401
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14401
APN LICENSE
TN
01
—
91906
RN LICENSE
TN
Enumeration date
06/24/2009
Last updated
10/06/2009
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