Individual
JO E WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4000 KRESGE WAY, LOUISVILLE, KY 40207-4605
(502) 259-5391
(502) 259-9733
Mailing address
PO BOX 34748, LOUISVILLE, KY 40232-4748
(502) 259-5391
(502) 259-9733
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1718A
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100003500A
—
IN
05
—
74428913
—
KY
Enumeration date
08/09/2005
Last updated
11/16/2012
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