Healthcare Provider Details

I. General information

NPI: 1811947583
Provider Name (Legal Business Name): LAURA DIANNE WILKENS MSN- CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18797 ALBERTA STREET
ONEIDA TN
37841-2127
US

IV. Provider business mailing address

12752 KINGSTON PIKE STE E202
KNOXVILLE TN
37934-0948
US

V. Phone/Fax

Practice location:
  • Phone: 865-777-0909
  • Fax: 865-777-0910
Mailing address:
  • Phone: 865-777-0909
  • Fax: 865-777-0910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN1108135 ARNP4723A
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11198
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4723A
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number87629
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: