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Organization
WABASH VALLEY DERMATOLOGY AND MED SPA INC
Active
Organization
WABASH VALLEY DERMATOLOGY AND MED SPA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDSAY SUSAN WILSON NP (PRESIDENT)
(217) 712-9512
Entity
Organization
Contact information
Practice address
4949 E POPLAR DR, TERRE HAUTE, IN 47803-2434
(217) 712-9512
Mailing address
18017 N WEAVER RD, MARSHALL, IL 62441-4071
(217) 712-9512
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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