Individual
GREGORY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1515 UNION AVE, MOBERLY, MO 65270-9407
(573) 686-5550
Mailing address
1303 QUAIL HAVEN DR, MOBERLY, MO 65270-3837
(573) 686-5550
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
132362
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125164
MO BCBS
MO
Enumeration date
01/30/2006
Last updated
04/02/2008
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