Individual
DANETTE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2732 W MICHIGAN ST, INDIANAPOLIS, IN 46222-3750
(317) 554-4668
Mailing address
1001 W 10TH ST, INDIANAPOLIS, IN 46202-2859
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200885670
—
IN
Enumeration date
05/19/2008
Last updated
05/19/2008
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