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General NPI Number Information
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NPI Number | 1073924825
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Entity Type | Individual
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Provider Name | TEREASA KELLEY WILSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/14/2014
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 700 E UNIVERSITY AVE
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City | DES MOINES
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State | IA
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Zip | 50316-2302
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Country | US
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Telephone | 515-991-6935
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Fax |
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Provider Business Mailing Address
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Address Line | 16901 LAKESIDE HILLS CT
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City | OMAHA
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State | NE
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Zip | 68130-2318
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Country | US
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Telephone | 515-991-6935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 119753
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 101283
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | D119753
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License Number State | IA
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