Basic Information
| Provider Information | |||||||||
| NPI: | 1942273339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILSON | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | FALCON | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 157 | ||||||||
| Address2: | |||||||||
| City: | GRAPEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156340157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245276517 | ||||||||
| FaxNumber: | 7245276519 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 JEFFERSON AVE | ||||||||
| Address2: | MERCY JEANNETTE HOSPITAL | ||||||||
| City: | JEANNETTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156440600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245273551 | ||||||||
| FaxNumber: | 7245276519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 09/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN242613L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.