Provider Demographics
NPI:1316374820
Name:WILSEY, MARCUS JAY (CRNA)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:JAY
Last Name:WILSEY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190371
Mailing Address - Street 2:
Mailing Address - City:HUNGRY HORSE
Mailing Address - State:MT
Mailing Address - Zip Code:59919-0371
Mailing Address - Country:US
Mailing Address - Phone:406-249-8451
Mailing Address - Fax:
Practice Address - Street 1:9589 HIGHWAY 2 EAST
Practice Address - Street 2:
Practice Address - City:MARTIN CITY
Practice Address - State:MT
Practice Address - Zip Code:59926
Practice Address - Country:US
Practice Address - Phone:406-249-8451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60404040367500000X
WA60417368367500000X
MT100143367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered