Healthcare Provider Details

I. General information

NPI: 1023054244
Provider Name (Legal Business Name): JOE NORMAN WILKES II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHWEST MEDICAL CENTER 1530 US HIGHWAY 43
WINFIELD AL
35594
US

IV. Provider business mailing address

226 BRANDY DRIVE
WINFIELD AL
35594
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-7000
  • Fax: 205-487-7645
Mailing address:
  • Phone: 205-487-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-094772
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: