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NPI Code Detail

MEDICARE: LUKE WILSON

MEDICARE:   LUKE  WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse Anesthetist42181TN

General Provider Information

NPI Number : 1356163646
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUKE WILSON
Provider Business Mailing Address
First Line : 874 UNION AVE RM 325
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-3514
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 874 UNION AVE RM 325
Second Line :
City : MEMPHIS
State : TN
Zip : 38103-3514
Country : US
Telephone Number : 901-448-6128
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2024
Last Update Date : 06/11/2026

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Directions to “ LUKE WILSON ” Practice Location

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