Individual
REGENIA L. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 STATE ST, MCCALL, ID 83638-3704
(208) 634-2221
(208) 634-7112
Mailing address
4283 N NINES RIDGE LN, BOISE, ID 83702-1866
(208) 345-5830
(208) 345-5830
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA109
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010017281
REGENCE
ID
01
—
89250
BLUE CROSS GROUP #
ID
01
—
A4092
BLUE CROSS
ID
Enumeration date
08/13/2006
Last updated
07/09/2007
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