Individual
JEREMY L WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
888 SWIFT BLVD, RICHLAND, WA 99352-3514
(770) 643-5619
(678) 352-4322
Mailing address
2655 NORTHWINDS PKWY, ALPHARETTA, GA 30009-2280
(770) 643-5619
(678) 352-4322
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
212544-6
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60607230
WA
Other
Enumeration date
09/17/2015
Last updated
10/27/2015
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