Individual
MR. JERALD EDWIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
607 BEAMAN ST, CLINTON, NC 28328-2603
(910) 592-8511
(910) 590-8761
Mailing address
PO BOX 1274, 4343 HWY 701 NORTH, ELIZABETHTOWN, NC 28337-1274
(910) 879-9886
(910) 590-8761
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
029672
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8050558
—
NC
Enumeration date
02/05/2007
Last updated
07/08/2007
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