Individual
STEVEN G WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 577-4200
(317) 577-4200
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28280811A
IN
367500000X
Certified Registered Nurse Anesthetist
APRNCRNA019502
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
095200132
MEDICARE PTAN
IN
01
—
264430H09
MEDICARE
IN
05
—
300005735
—
IN
Enumeration date
04/26/2017
Last updated
05/03/2023
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