Basic Information
Provider Information
NPI: 1003803131
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILSON
FirstName: NORMA
MiddleName: D.
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1245 S CEDAR CREST BLVD
Address2: SUITE #301
City: ALLENTOWN
State: PA
PostalCode: 181036258
CountryCode: US
TelephoneNumber: 6104029099
FaxNumber: 6104029029
Practice Location
Address1: 1200 S CEDAR CREST BLVD
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181036202
CountryCode: US
TelephoneNumber: 6104029099
FaxNumber: 6104029029
Other Information
ProviderEnumerationDate: 10/04/2005
LastUpdateDate: 03/25/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN247004LPAN Nursing Service ProvidersRegistered Nurse 
367500000X047089PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
1178371201PACAQHOTHER
00173742400505PA MEDICAID
0322610101PACAPITAL ADVANTAGEOTHER
8287301PAGEISINGEROTHER
990845601PAAETNAOTHER
134444501PAHIGHMARKOTHER
134444501PAKHP CENTRALOTHER
154838201PAGATEWAYOTHER
134444501PAFIRST PRIORITYOTHER
20370200001PAINDEP. BLUE CROSSOTHER


Home