Individual
DEEDEE WILFONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
708 E BRADFORD ST, MARION, IN 46952-2959
(765) 618-8798
Mailing address
708 E BRADFORD ST, MARION, IN 46952-2959
(765) 618-8798
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27067591A
IN
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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