Individual
MARLENE MARY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6745 GRAY RD STE D, INDIANAPOLIS, IN 46237-3236
(317) 859-1090
(317) 941-7254
Mailing address
PO BOX 100, BEECH GROVE, IN 46107-0100
(317) 859-1090
(317) 941-7254
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71000629A
IN
363LF0000X
Family Nurse Practitioner
Primary
71000629A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000033846
M PLAN
IN
01
—
000000545372
ANTHEM
IN
01
—
11533126
CAQH
IN
05
—
200509870
—
IN
01
—
28086560A
RN LICENSE
IN
01
—
71000629B
CSR
IN
01
—
P00303828
RAILROAD MEDICARE
IN
Enumeration date
01/23/2007
Last updated
03/07/2023
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