Provider Demographics
NPI:1003803131
Name:WILSON, NORMA D (CRNA)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:D
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1245 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6258
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN247004L163W00000X
PA047089367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1344445OtherHIGHMARK
PA1548382OtherGATEWAY
PA9908456OtherAETNA
PA11783712OtherCAQH
PA1344445OtherKHP CENTRAL
PA203702000OtherINDEP. BLUE CROSS
PA82873OtherGEISINGER
PA03226101OtherCAPITAL ADVANTAGE
PA001737424005Medicaid
PA1344445OtherFIRST PRIORITY
PA1548382OtherGATEWAY
PA203702000OtherINDEP. BLUE CROSS
PA1344445OtherKHP CENTRAL