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General NPI Number Information
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NPI Number | 1841296811
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Entity Type | Individual
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Provider Name | MARCIA H WILSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2131 S 17TH ST
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City | WILMINGTON
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State | NC
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Zip | 28401-7407
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Country | US
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Telephone | 910-343-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 367 KNOLLWOOD DR
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8440
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Country | US
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Telephone | 910-270-6163
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN-149702-L
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License Number State | PA
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