Provider Demographics
NPI:1578630752
Name:WILSON, CATHERINE ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 BLUE STEM CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8990
Mailing Address - Country:US
Mailing Address - Phone:605-661-6979
Mailing Address - Fax:
Practice Address - Street 1:1201 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747-8800
Practice Address - Country:US
Practice Address - Phone:605-661-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000635367500000X
NE101135367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered