Individual
MR. JOSEPH SAMUEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2595
(952) 883-7172
Mailing address
PO BOX 1309 - MAIL STOP 21110Q, MINNEAPOLIS, MN 55440-1309
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1651348
MN
Other
Enumeration date
09/27/2018
Last updated
09/27/2018
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