Individual
MRS. JENNIFER GAYLE WILCOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1629 MEDICAL ARTS BLVD, ANDERSON, IN 46011-3454
(765) 298-4220
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28212115A
IN
363LF0000X
Family Nurse Practitioner
Primary
71014884A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300085766
—
IN
Enumeration date
12/07/2023
Last updated
02/05/2024
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