Individual
TIMOTHY SCOTT WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 772-9202
(910) 772-9452
Mailing address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 772-9202
(910) 772-9452
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
194802
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
082174
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568696938
TRICARE
NC
05
—
8053539
—
NC
01
—
P00754280
RAILROAD MEDICARE
NC
Enumeration date
05/13/2009
Last updated
03/17/2021
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