Healthcare Provider Details

I. General information

NPI: 1275967291
Provider Name (Legal Business Name): DEBRA R WILSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA R WILSON RN

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS AIRPORT ROAD
SITKA AK
99835
US

IV. Provider business mailing address

222 TONGASS AIRPORT ROAD
SITKA AK
99835
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8431
  • Fax: 907-966-8448
Mailing address:
  • Phone: 907-966-8431
  • Fax: 907-966-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number34206
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number34206
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: