Individual
WANDA O WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, PHD
Contact information
Practice address
234 GOODMAN ST, CINCINNATI, OH 45219-2364
(513) 872-7388
(513) 872-7385
Mailing address
2368 VICTORY PKWY, SUITE 501, CINCINNATI, OH 45206-2859
(513) 872-7388
(513) 872-7385
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN-111273
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000277561
ANTHEM
—
05
—
0738974
—
OH
01
—
728038
BUCKEYE
—
05
—
74206079
—
KY
Enumeration date
06/09/2006
Last updated
04/08/2008
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