Provider Demographics
NPI:1487641742
Name:WILSON, JUNE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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:610-402-8896
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:2545 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7300
Practice Address - Country:US
Practice Address - Phone:610-402-8896
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN289957L163W00000X
PA046889367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2211727000OtherINDEP. BLUE CROSS
PA50078010OtherCAPITAL BLUE CROSS
PA50018385OtherCAPITAL ADVANTAGE
PA1525445OtherHIGHMARK
PA1525445OtherKHP CENTRAL
PA75375OtherGEISINGER
PAP00027150OtherRAIL ROAD MEDICARE
PA75375OtherGEISINGER
PA006023Q1RMedicare PIN
PAP00027150OtherRAIL ROAD MEDICARE
PA50018385OtherCAPITAL ADVANTAGE