Individual
JENNIFER LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-3241
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01063111A
IN
207Q00000X
Family Medicine Physician
Primary
01063111A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000564472
ANTHEM BC/BS
IN
01
—
000000711665
ANTHEM BC/BS
IN
05
—
200880830A
—
IN
01
—
P00775321
RAILROAD MEDICARE
IN
01
—
P00841097
RAILROAD MEDICARE
IN
01
—
P01087706
RAILROAD MEDICARE
IN
01
—
P01403061
RAILROAD MEDICARE
IN
Enumeration date
05/31/2007
Last updated
03/02/2021
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