Jimmy-John Clifford Wilson, CRNA
Nurse Anesthetist, Certified Registered in Greenville, NC. Individual provider (NPI-1).
NPI number1194875112
StatusActive
Last updated in NPPESJul 24, 2020
Details
- NPI
- 1194875112
- Entity type
- Individual (NPI-1)
- Name
- Jimmy-John Clifford Wilson
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 11, 2007
- Certification date
- Jul 24, 2020
- Last updated
- Jul 24, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 075318 | NC | Yes |
| 163W00000X | Registered Nurse | 162260 | NC |
Practice location
2080 W Arlington Blvd Ste BGreenville, NC 27834
Phone 252-752-2140 · Fax 252-689-6502
Mailing address
2080 W Arlington Blvd Ste BGreenville, NC 27834-3770
Phone 252-752-2140 · Fax 252-689-6502
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