MEDICARE: JOHN E. WILSON JR. 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
1	163W00000X	Registered Nurse	R145444	MD
2	367500000X	Certified Registered Nurse Anesthetist	R145444	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720233745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN E. WILSON JR. CRNA

Provider Business Mailing Address
First Line	:	278A BOWMAN LOOP
Second Line	:
City	:	WEST POINT
State	:	NY
Zip	:	10996-1002
Country	:	US
Telephone Number	:	410-371-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	WEST POINT ARMY MEDICAL CTR
Second Line	:	900 WASHINGTON RD
City	:	WEST POINT
State	:	NY
Zip	:	10996-0001
Country	:	US
Telephone Number	:	845-938-0749
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	04/17/2020

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