Individual
SARAH J. WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7120 CLEARVISTA DRIVE, SUITE 2100, INDIANAPOLIS, IN 46256-0020
(317) 621-5676
(317) 353-9338
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001549A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000825360
ANTHEM
IN
01
—
P01214579
RR MEDICARE PTAN
IN
Enumeration date
06/06/2013
Last updated
12/08/2014
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