Individual
JAQUIESE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5070 MATTESON DR, INDIANAPOLIS, IN 46235
(317) 229-5877
Mailing address
5070 MATTESON DR, INDIANAPOLIS, IN 46235
(317) 229-5877
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27081237A
IN
Other
Enumeration date
03/06/2025
Last updated
03/06/2025
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