Individual
MRS. DENISE BLAIR WILBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1802 E 10TH ST, JEFFERSONVILLE, IN 47130-6016
(812) 288-2488
(770) 573-9513
Mailing address
2100 MARKET ST STE 101, CHARLESTOWN, IN 47111-9535
(812) 503-5100
(770) 573-9513
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
71001728A
IN
363LF0000X
Family Nurse Practitioner
Primary
3004516
KY
363LF0000X
Family Nurse Practitioner
4516P
KY
363LF0000X
Family Nurse Practitioner
71001728A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105450
RN LICENSE
KY
01
—
3004516
LICENSE NUMBER
KY
01
—
4526P
ARNP LICENSE
KY
01
—
71001728A
LICENSE NUMBER
IN
01
—
K156040
MEDICARE PTAN
KY
Enumeration date
06/26/2006
Last updated
11/08/2021
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