MEDICARE: MR. JAMES WILSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	26NR09354100	NJ
2	367500000X	Certified Registered Nurse Anesthetist	L6-0A00714	DE
3	367500000X	Certified Registered Nurse Anesthetist	RN318428L	PA

General Provider Information

NPI Number	:	1295741650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES WILSON CRNA

Provider Business Mailing Address
First Line	:	825 OLD LANCASTER RD STE 320
Second Line	:
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3235
Country	:	US
Telephone Number	:	610-527-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 OLD LANCASTER RD STE 330
Second Line	:
City	:	BRYN MAWR
State	:	PA
Zip	:	19010-3235
Country	:	US
Telephone Number	:	484-380-2880
Fax Number	:	610-672-0302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/08/2025

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