Provider Demographics
NPI:1275967291
Name:WILSON, DEBRA R (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:R
Last Name:WILSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:R
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:222 TONGASS AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-966-8431
Mailing Address - Fax:907-966-8448
Practice Address - Street 1:222 TONGASS AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835
Practice Address - Country:US
Practice Address - Phone:907-966-8431
Practice Address - Fax:907-966-8448
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK34206163WC0200X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency