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NPI Code Detail

MEDICARE: PATRICIA WILSON CRNA

MEDICARE: PATRICIA WILSON CRNA
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 Anesthetist2531CA

General Provider Information

NPI Number : 1699832998
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA WILSON CRNA
Provider Business Mailing Address
First Line : 280 W MACARTHUR BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94611-5642
Country : US
Telephone Number : 510-752-6238
Fax Number :
Provider Business Practice Location Address
First Line : 3600 BROADWAY
Second Line :
City : OAKLAND
State : CA
Zip : 94611-5730
Country : US
Telephone Number : 510-752-6238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2007
Last Update Date : 01/03/2022

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Directions to “ PATRICIA WILSON CRNA” Practice Location

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